Provider Demographics
NPI:1124564604
Name:JOHNSON, TOWAKI
Entity Type:Individual
Prefix:
First Name:TOWAKI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 ZELDA RD STE 17
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2667
Mailing Address - Country:US
Mailing Address - Phone:334-322-6034
Mailing Address - Fax:334-593-8220
Practice Address - Street 1:2835 ZELDA RD STE 17
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2667
Practice Address - Country:US
Practice Address - Phone:334-322-6034
Practice Address - Fax:334-593-8220
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14978344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi