Healthcare Provider Details

I. General information

NPI: 1376833319
Provider Name (Legal Business Name): NINA SHEREE FORD JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MIDTOWN PARK E
MOBILE AL
36606-4117
US

IV. Provider business mailing address

11 MIDTOWN PARK E
MOBILE AL
36606-4117
US

V. Phone/Fax

Practice location:
  • Phone: 251-724-3025
  • Fax: 251-724-3005
Mailing address:
  • Phone: 251-724-3025
  • Fax: 251-724-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30958
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10030754
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: