Healthcare Provider Details

I. General information

NPI: 1336067511
Provider Name (Legal Business Name): MADISON ANN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3173 DAUPHIN ST UNIT A
MOBILE AL
36606-4061
US

IV. Provider business mailing address

10785 NORTHERN DANCER CT
DAPHNE AL
36526-0889
US

V. Phone/Fax

Practice location:
  • Phone: 251-301-8276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1-184903
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: