MEDICARE: DR. JOANN ELIZABETH JOHNSON MD

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	208000000X	Pediatrics Physician	4556	AL
2	208000000X	Pediatrics Physician	AL4556	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51518176	OTHER	AL	BLUE CROSS BLUE SHIELD
2	4483860	OTHER	AL	AETNA
3	51010283	OTHER	AL	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1403382	OTHER	AL	FIRST HEALTH

General Provider Information

NPI Number	:	1104809508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANN ELIZABETH JOHNSON MD

Provider Business Mailing Address
First Line	:	101 BOB WALLACE AVE SW
Second Line	:	SUITE E
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3847
Country	:	US
Telephone Number	:	256-539-5339
Fax Number	:	256-536-5111

Provider Business Practice Location Address
First Line	:	101 BOB WALLACE AVE SW
Second Line	:	SUITE E
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3847
Country	:	US
Telephone Number	:	256-539-5339
Fax Number	:

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	04/05/2022

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Directions to “ DR. JOANN ELIZABETH JOHNSON MD” Practice Location

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