Organization
VANESSA O. JOHNSON,M.D.,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA O. JOHNSON M.D. (PRESIDENT/OWNER)
(804) 732-7100
Entity
Organization
Contact information
Practice address
50 MEDICAL PARK BOULEVARD, SUITE B, PETERSBURG, VA 23805
(804) 732-7100
(804) 732-7101
Mailing address
50 MEDICAL PARK BOULEVARD, SUITE B, PETERSBURG, VA 23805
(804) 732-7100
(804) 732-7101
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0101039958
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396866448
NPI
VA
Enumeration date
10/14/2008
Last updated
10/14/2008
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