Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 0101230804 | VA |
NPI | 1023104650 |
---|---|
Provider Name | Randall Wayne Johnson |
First Address | Richmond, VA 23225-4017 |
Second Address | Richmond, VA 23225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |