Healthcare Provider Details

I. General information

NPI: 1356867063
Provider Name (Legal Business Name): DONNA K JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 BUFORD L ROLIN DR
ATMORE AL
36502-5190
US

IV. Provider business mailing address

5811 JACK SPRINGS RD
ATMORE AL
36502-5025
US

V. Phone/Fax

Practice location:
  • Phone: 251-368-9136
  • Fax:
Mailing address:
  • Phone: 251-368-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-072152
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: