Provider Demographics
NPI:1053637934
Name:CAROL M JOHNSON MD LLC
Entity Type:Organization
Organization Name:CAROL M JOHNSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-664-7570
Mailing Address - Street 1:224 1ST ST N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8767
Mailing Address - Country:US
Mailing Address - Phone:205-664-7570
Mailing Address - Fax:205-664-7584
Practice Address - Street 1:224 1ST ST N
Practice Address - Street 2:SUITE 200
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8767
Practice Address - Country:US
Practice Address - Phone:205-664-7570
Practice Address - Fax:205-664-7584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD11601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-07223OtherBLUE CROSS PROVIDER NUMBER
ALC72420Medicare UPIN
AL5101080121Medicare PIN