Provider Demographics
NPI:1144285305
Name:JOHNSON, WAYNE MILTON II (PA-C)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:MILTON
Last Name:JOHNSON
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1625 N GEORGE MASON DR STE 334
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3690
Mailing Address - Country:US
Mailing Address - Phone:703-717-4180
Mailing Address - Fax:703-717-4181
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-4001
Practice Address - Fax:703-776-7113
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
1070743363A00000X
DC031346363AS0400X
VA0110005872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN