MEDICARE: DR. GEORGE MICHAEL JOHNSON JR. D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	00041	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	H589	OTHER	AL	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0495240001	OTHER	AL	DME PIN

General Provider Information

NPI Number	:	1437130564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE MICHAEL JOHNSON JR. D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 8407
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36689-0407
Country	:	US
Telephone Number	:	251-343-5971
Fax Number	:	251-343-7589

Provider Business Practice Location Address
First Line	:	705 BISHOP LN N
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-5838
Country	:	US
Telephone Number	:	251-343-5971
Fax Number	:	251-343-7589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	12/07/2007

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