Provider Demographics
NPI:1568512465
Name:JOHNSON, JULIE BAILEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:BAILEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:45155 RESEARCH PL
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4191
Mailing Address - Country:US
Mailing Address - Phone:703-858-0500
Mailing Address - Fax:703-858-5155
Practice Address - Street 1:45155 RESEARCH PL
Practice Address - Street 2:SUITE 140
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4191
Practice Address - Country:US
Practice Address - Phone:703-858-0500
Practice Address - Fax:703-858-5155
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002444363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant