Provider Demographics
NPI:1912018029
Name:JOHNSON, GEORGE DAVID JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DAVID
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CRESTWOOD BLVD
Mailing Address - Street 2:STE 211
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2034
Mailing Address - Country:US
Mailing Address - Phone:205-271-6851
Mailing Address - Fax:
Practice Address - Street 1:2302 CENTER POINT PKWY
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:AL
Practice Address - Zip Code:35215-3608
Practice Address - Country:US
Practice Address - Phone:205-853-9170
Practice Address - Fax:205-271-6856
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0133051223G0001X
AL47941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009927145Medicaid
GA199219578AMedicaid
AL009933952Medicaid
AL009976855Medicaid
AL009976855Medicaid