Provider Demographics
NPI:1437130564
Name:JOHNSON, GEORGE MICHAEL JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8407
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36689-0407
Mailing Address - Country:US
Mailing Address - Phone:251-343-5971
Mailing Address - Fax:251-343-7589
Practice Address - Street 1:705 BISHOP LN N
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-5838
Practice Address - Country:US
Practice Address - Phone:251-343-5971
Practice Address - Fax:251-343-7589
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00041213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0495240001OtherDME PIN
ALH589OtherMEDICARE GROUP
AL0495240001OtherDME PIN