Healthcare Provider Details

I. General information

NPI: 1063329118
Provider Name (Legal Business Name): ZACHARY SCOTT JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 PALE DAWN PL SE
OWENS CROSS ROADS AL
35763-9074
US

IV. Provider business mailing address

7108 PALE DAWN PL SE
OWENS CROSS ROADS AL
35763-9074
US

V. Phone/Fax

Practice location:
  • Phone: 256-698-6794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: