Provider Demographics
NPI:1750981866
Name:JOHNSON, MADISON LLOYD (MPAS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:LLOYD
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:MS
Other - First Name:MADISON
Other - Middle Name:EMILY
Other - Last Name:LLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS, PA-C
Mailing Address - Street 1:PO BOX 980153
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0153
Mailing Address - Country:US
Mailing Address - Phone:804-586-7060
Mailing Address - Fax:
Practice Address - Street 1:13048 RIVERS BEND RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-2564
Practice Address - Country:US
Practice Address - Phone:804-526-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-007490363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant