Johnson, Russell

Johnson, Russell is an individual health care provider with primary practice located at 601 Old Wagner Rd Suite 101, Petersburg VA 23805-9313. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Johnson, Russell can be contacted via phone (804) 524-2260.

Contact Information

Primary practice address
601 Old Wagner Rd Suite 101 Petersburg VA 23805-9313
Fax: (804) 524-0096
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 0101045410 Virginia

Profile Details

NPI number 1447205554
LBN Legal business name Johnson, Russell
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2006
Last updated Jul 7th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447205554 NPPES
Virginia Other 194501 ANTHEM

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