Individual
VANESSA O JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
50 MEDICAL PARK BLVD, SUITE B, PETERSBURG, VA 23805-9275
(804) 732-7100
(804) 732-7101
Mailing address
50 MEDICAL PARK BLVD, SUITE B, PETERSBURG, VA 23805-9275
(804) 732-7100
(804) 732-7101
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
39958
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093967788
GROUP NPI
VA
Enumeration date
04/03/2007
Last updated
03/02/2009
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