| Vanessa O. Johnson,m.d.,pc | |
|
50 Medical Park Boulevard Suite B Petersburg VA 23805 | |
| (804) 732-7100 | |
| (804) 732-7101 |
| Full Name | Vanessa O. Johnson,m.d.,pc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 50 Medical Park Boulevard, Petersburg, Virginia |
| Authorized Official Name and Position | Vanessa O. Johnson (PRESIDENT/OWNER) |
| Authorized Official Contact | 8047327100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vanessa O. Johnson,m.d.,pc 50 Medical Park Boulevard Suite B Petersburg VA 23805 Ph: (804) 732-7100 | Vanessa O. Johnson,m.d.,pc 50 Medical Park Boulevard Suite B Petersburg VA 23805 Ph: (804) 732-7100 |
| NPI Number | 1093967788 |
|---|---|
| Provider Enumeration Date | 10/14/2008 |
| Last Update Date | 10/14/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093967788 | NPI | - | NPPES |
| 1396866448 | Other | VA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 0101039958 (Virginia) | Primary |
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