MEDICARE: MR. THOMAS D. JOHNSON MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0728C	AL

General Provider Information

NPI Number	:	1083636336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS D. JOHNSON MSW

Provider Business Mailing Address
First Line	:	3445 S VALLEY RD
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-8110
Country	:	US
Telephone Number	:	256-504-1683
Fax Number	:	256-504-1683

Provider Business Practice Location Address
First Line	:	3445 S VALLEY RD
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-8110
Country	:	US
Telephone Number	:	256-504-1683
Fax Number	:	256-504-1683

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	09/15/2025

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