Provider Demographics
NPI:1912192402
Name:RALPH H. JOHNSON VA MEDICAL CENTER
Entity Type:Organization
Organization Name:RALPH H. JOHNSON VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIAMRY CARE SOCIAL WORKER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:MCDANIEL
Authorized Official - Last Name:FOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-685-0537
Mailing Address - Street 1:91 BOGARD ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5230
Mailing Address - Country:US
Mailing Address - Phone:850-685-0537
Mailing Address - Fax:
Practice Address - Street 1:91 BOGARD ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5230
Practice Address - Country:US
Practice Address - Phone:850-685-0537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital