Provider Demographics
NPI:1851093850
Name:BOOKHARDT, JOHNNY JR
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:
Last Name:BOOKHARDT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9157 ATLEE RD STE A
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2504
Mailing Address - Country:US
Mailing Address - Phone:804-215-4340
Mailing Address - Fax:804-522-0405
Practice Address - Street 1:9157 ATLEE RD STE A
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2504
Practice Address - Country:US
Practice Address - Phone:804-215-4340
Practice Address - Fax:804-522-0405
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver