Individual
DR. DIANE LEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., A.A.F.P.
Contact information
Practice address
2367 COLONY CROSSING PL, MIDLOTHIAN, VA 23112-4280
(804) 323-1264
(804) 323-1276
Mailing address
607 BIGGIN POND RD, MIDLOTHIAN, VA 23114-4589
(804) 323-1264
(804) 323-1276
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101058870
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VVF389A
MEDICARE PTAN
—
Enumeration date
08/23/2005
Last updated
08/03/2016
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