=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588864466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELA ROSS-JOHNSON, MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2007
-----------------------------------------------------
Last Update Date | 07/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 WEST DUBLIN DR.
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-772-0606
-----------------------------------------------------
Fax | 256-772-0676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 WEST DUBLIN DRIVE
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-772-0606
-----------------------------------------------------
Fax | 256-772-0676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANGELA ROSS-JOHNSON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 256-772-0606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 13200
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------