Provider Demographics
NPI:1477514180
Name:JOHNSON, LLOYD III (MD)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:
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 1:120 CAHABA VALLEY PARKWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1826
Mailing Address - Country:US
Mailing Address - Phone:205-621-3778
Mailing Address - Fax:205-621-4835
Practice Address - Street 1:120 CAHABA VALLEY PARKWAY
Practice Address - Street 2:STE 100
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1826
Practice Address - Country:US
Practice Address - Phone:205-621-3778
Practice Address - Fax:205-621-4835
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025810207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL126924Medicaid
ALP00955871OtherPTAN
ALP00955871OtherPTAN
H62683Medicare UPIN