MEDICARE: BIRMINGHAM PLASTIC SURGERY CLINIC, PA

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	174400000X	Specialist	00009687	AL

General Provider Information

NPI Number	:	1851571996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRMINGHAM PLASTIC SURGERY CLINIC, PA

Provider Business Mailing Address
First Line	:	1 OFFICE PARK CIR
Second Line	:	SUITE 200
City	:	BIRMINGHAM
State	:	AL
Zip	:	35223-2514
Country	:	US
Telephone Number	:	205-871-8307
Fax Number	:	205-871-8328

Provider Business Practice Location Address
First Line	:	1 OFFICE PARK CIR
Second Line	:	SUITE 200
City	:	BIRMINGHAM
State	:	AL
Zip	:	35223-2514
Country	:	US
Telephone Number	:	205-871-8307
Fax Number	:	205-871-8328

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BENJAMIN HARDY JOHNSON III
Credential	:	M.D.
Telephone Number	:	205-871-8307

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	11/06/2007

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