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Mr. Russell Johnson
Specialist in Petersburg, Virginia
NPI 1447205554

Russell Johnson is a Specialist based in Petersburg, VA. Russell Johnson practices in Petersburg, VA. The NPI Number for Russell Johnson is 1447205554 and holds a License No. 0101045410 (Virginia).

The current practice location address for Russell Johnson is 601 Old Wagner Rd, Petersburg, VA and can be reached out via phone at 804-524-2260 and via fax at 804-524-0096.

Location: 601 Old Wagner Rd, Petersburg, VA, 23805-9313
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1447205554
Provider Name
Russell Johnson
Credential
Provider Entity Type
Individual
Gender
Male
Address
601 Old Wagner Rd, Petersburg, VA, 23805-9313
Phone Number
804-524-2260
Fax Number
804-524-0096
Provider Enumeration Date
05/24/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
194501 01 VA ANTHEM
institution
Provider Business Practice Location Address Details
Address
601 Old Wagner Rd
City
Petersburg
State
Virginia
Zip
23805-9313
Phone Number
804-524-2260
Fax Number
804-524-0096
person
Provider Business Mailing Address Details
Address
601 Old Wagner Rd
City
Petersburg
State
Virginia
Zip
23805-9313
Phone Number
804-524-2260
Fax Number
804-524-0096
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
0101045410 (Virginia)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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