| Doctor Name: | DR. TEDDY R JOHNSON |
| NPI Number: | 1073576062 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 0103000769 |
| Business Practice Address: | 680 W Monroe St Wytheville, VA - 243822240 |
| Business Phone Number: | 2762282212 |
| Business Fax Number: | 2762287835 |
| Mailing Address: | 680 W Monroe St, WYTHEVILLE |
| State: | VA |
| Postal Code: | 243822240 |
| Phone Number: | 2762282212 |
| Fax Number: | 2762287835 |
| NPI Enumeration Date: | 04/10/2006 |
| NPI Last Update Date: | 10/25/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 0103000769 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |