Provider Demographics
NPI:1407426034
Name:JOHNSON, ANDREW PHILLIP (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:PHILLIP
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA-C
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Other - Middle Name:
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Mailing Address - Street 1:3241 WESTERN BRANCH BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:1510 SKYLARK CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-1245
Practice Address - Country:US
Practice Address - Phone:757-567-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-27
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-008093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant