Provider Demographics
NPI:1417920786
Name:JOHNSON, RODERICK G (MD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:G
Last Name:JOHNSON
Suffix:
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 1:901 LEIGHTON AVE
Mailing Address - Street 2:STE. 702
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5700
Mailing Address - Country:US
Mailing Address - Phone:256-237-1624
Mailing Address - Fax:256-238-0555
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:STE. 702
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5700
Practice Address - Country:US
Practice Address - Phone:256-237-1624
Practice Address - Fax:256-238-0555
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3531174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51003265OtherBLUE CROSS BLUE SHIELD
AL14274OtherHEALTH STRATEGIES
AL14274OtherHEALTH STRATEGIES