Provider Demographics
NPI:1184668535
Name:JOHNSON, ALISA BARR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:BARR
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:CAROL
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3909 MCFARLAND BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476
Mailing Address - Country:US
Mailing Address - Phone:205-333-1993
Mailing Address - Fax:205-333-0782
Practice Address - Street 1:3909 MCFARLAND BOULEVARD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476
Practice Address - Country:US
Practice Address - Phone:205-333-1993
Practice Address - Fax:205-333-0782
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18467207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07650330Medicaid
MS07650330Medicaid