Provider Demographics
NPI:1609858372
Name:JOHNSON, JOSEPH T JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:JOHNSON
Suffix:JR
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 1:503 CLARK ST NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-1921
Mailing Address - Country:US
Mailing Address - Phone:256-739-0801
Mailing Address - Fax:256-739-0027
Practice Address - Street 1:1800 AL HIGHWAY 157
Practice Address - Street 2:SUITE 101
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-1271
Practice Address - Country:US
Practice Address - Phone:256-739-4131
Practice Address - Fax:256-739-6027
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL117964Medicaid
AL1164743068Medicaid
AL51026285OtherBCBS OF AL
ALF57463Medicare UPIN
AL080080740Medicare PIN