Johnson, Tairy Adams
Johnson, Tairy Adams is an individual health care provider with primary practice located at 2300 Opitz Blvd , Woodbridge VA 22191-3311. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Johnson, Tairy Adams can be contacted via phone (703) 523-1504.Contact Information
Primary practice address
2300 Opitz Blvd
Woodbridge VA 22191-3311
Phone: (703) 523-1504
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 0110001991 | Virginia |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 0110001991 | Virginia |
Profile Details
| NPI number | 1063468890 |
|---|---|
| LBN Legal business name | Johnson, Tairy Adams |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 25th, 2006 |
| Last updated | Aug 4th, 2021 - about 5 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063468890 | NPPES |
| Virginia | MEDICAID | 010209838 | |
| Virginia | MEDICAID | 010209889 | |
| Virginia | MEDICAID | 010209862 |
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