| Doctor Name: | MRS. JULIE RANDOLPH JOHNSON |
| NPI Number: | 1013300383 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 5007496 |
| Business Practice Address: | 14121 Parke Long Ct Ste 201 Chantilly, VA - 201511647 |
| Business Phone Number: | 5713647110 |
| Business Fax Number: | 8007522471 |
| Mailing Address: | 14121 Parke Long Ct Ste 201, CHANTILLY |
| State: | VA |
| Postal Code: | 201511647 |
| Phone Number: | 5712647110 |
| Fax Number: | 8007522471 |
| NPI Enumeration Date: | 03/11/2015 |
| NPI Last Update Date: | 03/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 5007496 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |