Provider Demographics
NPI:1508014457
Name:JOHNSON, ANDREANA MEGAN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREANA
Middle Name:MEGAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 US HIGHWAY 431
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-5934
Mailing Address - Country:US
Mailing Address - Phone:256-840-3396
Mailing Address - Fax:256-840-3394
Practice Address - Street 1:2525 US HIGHWAY 431
Practice Address - Street 2:SUITE 200
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5934
Practice Address - Country:US
Practice Address - Phone:256-840-3396
Practice Address - Fax:256-840-3394
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN11180207V00000X
ALMD31039207V00000X
FLME106466207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology