Healthcare Provider Details

I. General information

NPI: 1205068525
Provider Name (Legal Business Name): ANKREHAH TRIMBLE JOHNSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MEDICAL PARK DR E SUITE 154
BIRMINGHAM AL
35235-3400
US

IV. Provider business mailing address

48 MEDICAL PARK DR E SUITE 154
BIRMINGHAM AL
35235-3400
US

V. Phone/Fax

Practice location:
  • Phone: 205-202-5650
  • Fax: 205-202-5655
Mailing address:
  • Phone: 205-202-5650
  • Fax: 205-202-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO 1167
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberDO 1167
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberDO 1167
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberDO 1167
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: