Healthcare Provider Details

I. General information

NPI: 1033658588
Provider Name (Legal Business Name): LORI ELIZABETH JOHNSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI MILLS JOHNSTON LOWE

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 DECATUR HWY STE 101
GARDENDALE AL
35071-2384
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-0116
US

V. Phone/Fax

Practice location:
  • Phone: 205-608-8199
  • Fax:
Mailing address:
  • Phone: 256-533-7064
  • Fax: 256-704-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-076910
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: