MEDICARE: RICHARD SAMUEL JOHNSON IV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1467387084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD SAMUEL JOHNSON IV

Provider Business Mailing Address
First Line	:	17 MORRISSEY STONE CT
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7682
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 MORRISSEY STONE CT
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7682
Country	:	US
Telephone Number	:	540-290-7316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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