Healthcare Provider Details

I. General information

NPI: 1396897252
Provider Name (Legal Business Name): GERALD ALLEN JOHNSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8103 HIGHWAY 72 W STE B
MADISON AL
35758-9529
US

IV. Provider business mailing address

8103 HIGHWAY 72 W STE B
MADISON AL
35758-9529
US

V. Phone/Fax

Practice location:
  • Phone: 256-461-0300
  • Fax: 256-864-8470
Mailing address:
  • Phone: 256-461-0300
  • Fax: 256-864-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1256
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: