Healthcare Provider Details

I. General information

NPI: 1538152483
Provider Name (Legal Business Name): JOHNNIE WAYNE STRICKLAND JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 INTERSTATE COMMERCIAL PARK LOOP
PRATTVILLE AL
36066-7361
US

IV. Provider business mailing address

PO BOX 680519
PRATTVILLE AL
36068-0519
US

V. Phone/Fax

Practice location:
  • Phone: 334-361-8225
  • Fax: 334-361-0377
Mailing address:
  • Phone: 334-361-8555
  • Fax: 866-923-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16079
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: