Healthcare Provider Details

I. General information

NPI: 1750199501
Provider Name (Legal Business Name): VIRGINIA F JOHNSTON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 11TH AVE S
BIRMINGHAM AL
35205-3423
US

IV. Provider business mailing address

2376 RIDGEMONT DR
BIRMINGHAM AL
35244-1219
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-8339
  • Fax: 205-930-7721
Mailing address:
  • Phone: 251-362-5135
  • Fax: 205-930-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2772
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: