Individual
TAIRY ADAMS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
2300 OPITZ BLVD, WOODBRIDGE, VA 22191-3311
(703) 523-1504
Mailing address
2300 OPITZ BLVD, WOODBRIDGE, VA 22191-3311
(703) 523-1504
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001991
VA
363AM0700X
Medical Physician Assistant
0110001991
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010209838
—
VA
05
—
010209862
—
VA
05
—
010209889
—
VA
Enumeration date
05/25/2006
Last updated
08/04/2021
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