Individual
MR. SHANNON PATRICK JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
1004 HERMITAGE RD, BLDG 2052, NORFOLK, VA 23521-5000
(757) 462-3178
Mailing address
1096 VALENCIA CT, VIRGINIA BEACH, VA 23454-6789
(757) 301-8921
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/08/2007
Last updated
07/08/2007
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