Individual
CLYDE L. JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1051 JOHNSTON WILLIS DR., ST. 200, RICHMOND, VA 23235
(804) 320-2705
(804) 330-2433
Mailing address
1051 JOHNSTON WILLIS DR., ST. 200, RICHMOND, VA 23235
(804) 320-2705
(804) 330-2433
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101-223144
VA
208600000X
Surgery Physician
0101223144
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7310871
—
VA
Enumeration date
01/11/2006
Last updated
03/10/2010
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