Provider Demographics
NPI:1114064979
Name:JOHNSON, DEBRA LYNN (RT(T))
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RT(T)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 PATHWAY PL
Mailing Address - Street 2:APT#A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2300
Mailing Address - Country:US
Mailing Address - Phone:919-426-3944
Mailing Address - Fax:
Practice Address - Street 1:307 N UNIVERSITY BLVD
Practice Address - Street 2:BLDG. CC CB-135
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3053
Practice Address - Country:US
Practice Address - Phone:251-460-7160
Practice Address - Fax:251-460-6173
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1896132471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy