MEDICARE: DR. GEORGE DAVID JOHNSON JR. DDS

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	1223G0001X	General Practice Dentistry	DN013305	GA
2	1223G0001X	General Practice Dentistry	4794	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912018029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE DAVID JOHNSON JR. DDS

Provider Business Mailing Address
First Line	:	1900 CRESTWOOD BLVD
Second Line	:	STE 211
City	:	IRONDALE
State	:	AL
Zip	:	35210-2034
Country	:	US
Telephone Number	:	205-271-6851
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 CENTER POINT PKWY
Second Line	:
City	:	CENTER POINT
State	:	AL
Zip	:	35215-3608
Country	:	US
Telephone Number	:	205-853-9170
Fax Number	:	205-271-6856

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/29/2010

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Directions to “ DR. GEORGE DAVID JOHNSON JR. DDS” Practice Location

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