Basic Information
| Provider Information | |||||||||
| NPI: | 1255590998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | FAYEMI | ||||||||
| MiddleName: | SYLVANUS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, CSA. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20486 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | ONANCOCK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234174309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573022700 | ||||||||
| FaxNumber: | 7577879262 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 VARNUM STREET, NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200172104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028547074 | ||||||||
| FaxNumber: | 2028547470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2008 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant | 207V00000X | 0101264106 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD044224 | DC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.