Provider Demographics
NPI:1336467406
Name:JOHNSON, NATHAN WARREN (D,MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:WARREN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:D,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 RIVER WALK CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-6811
Mailing Address - Country:US
Mailing Address - Phone:205-994-5832
Mailing Address - Fax:
Practice Address - Street 1:1451 RIVER WALK CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-6811
Practice Address - Country:US
Practice Address - Phone:205-994-5832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL56861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics