Provider Demographics
NPI:1326066184
Name:JOHNSON, DAVID PAUL (R, MR)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:R, MR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MITCHELL BLVD
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35904-3908
Mailing Address - Country:US
Mailing Address - Phone:256-543-8064
Mailing Address - Fax:
Practice Address - Street 1:12119 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-9344
Practice Address - Country:US
Practice Address - Phone:256-894-4440
Practice Address - Fax:256-894-4474
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
290255247100000X, 2471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging