Provider Demographics
NPI:1568442101
Name:JOHNSON, CHARLES K (PA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2025 E MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7069
Mailing Address - Country:US
Mailing Address - Phone:804-591-2890
Mailing Address - Fax:804-591-2896
Practice Address - Street 1:2025 E MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7069
Practice Address - Country:US
Practice Address - Phone:804-253-1997
Practice Address - Fax:804-253-1979
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110840813363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant