Healthcare Provider Details

I. General information

NPI: 1477578110
Provider Name (Legal Business Name): ERNEST VAN JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 JACK WARNER PKWY NE SUITE B-1
TUSCALOOSA AL
35404-5751
US

IV. Provider business mailing address

535 JACK WARNER PKWY NE SUITE B-1
TUSCALOOSA AL
35404-5751
US

V. Phone/Fax

Practice location:
  • Phone: 205-556-2121
  • Fax: 205-554-0152
Mailing address:
  • Phone: 205-556-2121
  • Fax: 205-554-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11457
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: