Provider Demographics
NPI:1902833916
Name:JOHNSON, WALTER HARVEY JR (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:HARVEY
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:PO BOX 55823
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5823
Mailing Address - Country:US
Mailing Address - Phone:205-934-4948
Mailing Address - Fax:205-212-3002
Practice Address - Street 1:1700 6TH AVE S
Practice Address - Street 2:SUITE 9100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1802
Practice Address - Country:US
Practice Address - Phone:205-934-4948
Practice Address - Fax:205-212-3002
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL126192080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00014896OtherMISSISSIPPI MEDICAID
AL2510133OtherUHC
AL51083871OtherBC BS
AL5283380OtherAETNA
AL000083871Medicaid
AL22070OtherHEALTHSPRING
C76721OtherVIVA
C76721Medicare UPIN
000083871Medicare ID - Type Unspecified