Healthcare Provider Details

I. General information

NPI: 1295779502
Provider Name (Legal Business Name): HENRY G. JOHNSON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 WOODLEY PARK DR
MONTGOMERY AL
36116-3834
US

IV. Provider business mailing address

2601 WOODLEY PARK DR
MONTGOMERY AL
36116-3834
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-3400
  • Fax: 334-288-0188
Mailing address:
  • Phone: 334-288-3400
  • Fax: 334-288-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. HENRY GOODWIN JOHNSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 334-288-3400