NPIMap

Organization Active NPI

Vanessa O. Johnson,M.D.,PC

  • Primary Care Clinic/Center
  • Petersburg, VA
National Provider Identifier
1093967788
Registry record updated Oct 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
0101039958 Issued in VA
Legal business name
VANESSA O. JOHNSON,M.D.,PC
Practice address
50 Medical Park Boulevard
Suite B
Petersburg, VA 23805
Phone
(804) 732-7100
Fax
(804) 732-7101
NPI assigned
Oct 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vanessa O. Johnson, M.D.
Title
President/Owner
Phone
(804) 732-7100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 0101039958 VA Primary

Addresses

Primary practice location

50 Medical Park Boulevard
Suite B
Petersburg, VA 23805

Mailing address

50 Medical Park Boulevard
Suite B
Petersburg, VA 23805
Phone (804) 732-7100

Other identifiers 1

IdentifierTypeStateIssuer
1396866448OtherVANPI

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223942400000",
    "number": "1093967788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 MEDICAL PARK BOULEVARD",
            "address_2": "SUITE B",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "23805",
            "telephone_number": "804-732-7100",
            "fax_number": "804-732-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 MEDICAL PARK BOULEVARD",
            "address_2": "SUITE B",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "23805",
            "telephone_number": "804-732-7100",
            "fax_number": "804-732-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANESSA O. JOHNSON,M.D.,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-14",
        "last_updated": "2008-10-14",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "804-732-7100",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "VA",
            "license": "0101039958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1396866448",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.