Healthcare Provider Details

I. General information

NPI: 1962760728
Provider Name (Legal Business Name): GINA ELIZABETH JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 INDEPENDENCE DR
BIRMINGHAM AL
35209-5710
US

IV. Provider business mailing address

3560 INDEPENDENCE DRIVE
BIRMINGHAM AL
35209-5722
US

V. Phone/Fax

Practice location:
  • Phone: 205-949-2806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD.65891
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: