Provider Demographics
NPI:1679776728
Name:JOHNSON, SHONNA JENE (MD)
Entity type:Individual
Prefix:
First Name:SHONNA
Middle Name:JENE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:191 FOX HILL RD
Practice Address - Street 2:SUITE D
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-2360
Practice Address - Country:US
Practice Address - Phone:757-850-1311
Practice Address - Fax:757-850-7315
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101241782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine