Healthcare Provider Details

I. General information

NPI: 1780615005
Provider Name (Legal Business Name): PHILIP N JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 6TH AVE S
BIRMINGHAM AL
35233-1601
US

IV. Provider business mailing address

PO BOX 55845
BIRMINGHAM AL
35255-5845
US

V. Phone/Fax

Practice location:
  • Phone: 205-279-2860
  • Fax: 205-252-0197
Mailing address:
  • Phone: 205-279-2860
  • Fax: 205-252-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6705
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: