Provider Demographics
NPI:1386658789
Name:JOHNSON, TOMMY (MD)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 JAMESTOWN RD
Mailing Address - Street 2:STE 103
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3362
Mailing Address - Country:US
Mailing Address - Phone:757-229-1259
Mailing Address - Fax:757-229-1303
Practice Address - Street 1:1313 JAMESTOWN RD
Practice Address - Street 2:STE 103
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3362
Practice Address - Country:US
Practice Address - Phone:757-229-1259
Practice Address - Fax:757-229-1303
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA097833OtherBCBS
VA5628199Medicaid
VA097833OtherBCBS