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Organization
DEGRAFT-JOHNSON MEDICAL ASSOCIATES PC
Active
Organization
DEGRAFT-JOHNSON MEDICAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LATIFA DEGRAFT-JOHNSON MD (VICE PRESIDENT)
(612) 669-5048
Entity
Organization
Contact information
Practice address
RR 1 BOX 6196, AGAPE MEDICAL CENTER, KINGSHILL, VI 00850-9826
(340) 772-2000
(340) 778-9798
Mailing address
RR 1 BOX 6196, AGAPE MEDICAL CENTER, KINGSHILL, VI 00850-9826
(340) 772-2000
(340) 778-9798
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1578
VI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
1579
VI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194970475
NPI
VI
01
—
1538111471
NPI
—
Enumeration date
03/11/2010
Last updated
09/30/2010
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