Provider Demographics
NPI:1194826875
Name:JOHNSON, BENJAMIN HARDY III (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:HARDY
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OFFICE PARK CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2514
Mailing Address - Country:US
Mailing Address - Phone:205-871-8307
Mailing Address - Fax:205-871-8328
Practice Address - Street 1:1 OFFICE PARK CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223-2514
Practice Address - Country:US
Practice Address - Phone:205-871-8307
Practice Address - Fax:205-871-8328
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00009687174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC75683Medicare UPIN