Provider Demographics
NPI:1164405502
Name:JOHNSON RAYFIELD, JULIA ANNETTE (DO)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ANNETTE
Last Name:JOHNSON RAYFIELD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:EASTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23347-1349
Mailing Address - Country:US
Mailing Address - Phone:757-678-5295
Mailing Address - Fax:757-678-5351
Practice Address - Street 1:16366 COURTHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:EASTVILLE
Practice Address - State:VA
Practice Address - Zip Code:23347-1349
Practice Address - Country:US
Practice Address - Phone:757-678-5295
Practice Address - Fax:757-678-5351
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7610408Medicaid
VA139650OtherANTHEM BCBS OF VA
VA7610408Medicaid
G70769Medicare UPIN