=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437130564
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGE MICHAEL JOHNSON JR. D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2005
-----------------------------------------------------
Last Update Date | 12/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 705 BISHOP LN N
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36608-5838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-343-5971
-----------------------------------------------------
Fax | 251-343-7589
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8407
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36689-0407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-343-5971
-----------------------------------------------------
Fax | 251-343-7589
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 00041
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------