Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 0101042937 | VA |
N | 207N00000X | Dermatologist | 048364 | GA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 0101042937 | VA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 048364 | GA |
N | 207ND0900X | Dermatopathologist | 048364 | GA |
N | 207NP0225X | Pediatric Dermatologist | 049364 | GA |
N | 207NS0135X | Procedural Dermatology | 048364 | GA |
N | 208D00000X | General Practice Physician | 048364 | GA |
NPI | 1164495115 |
---|---|
Provider Name | Dr. Brian L Johnson |
First Address | Norfolk, VA 23502-2233 |
Second Address | Norfolk, VA 23502-2233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 05/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
528051176 | (05) | GA |