Provider Demographics
NPI:1356870158
Name:JOHNSON, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:JOHNSON
Suffix:
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 1:7443 LEE DAVIS ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111
Mailing Address - Country:US
Mailing Address - Phone:866-810-8305
Mailing Address - Fax:877-316-3453
Practice Address - Street 1:52 SAINT PAULS RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:VA
Practice Address - Zip Code:22572-4436
Practice Address - Country:US
Practice Address - Phone:804-761-4872
Practice Address - Fax:804-493-8361
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle