Provider Demographics
NPI:1922047018
Name:JOHNSON, RONNY CARL (MD)
Entity Type:Individual
Prefix:
First Name:RONNY
Middle Name:CARL
Last Name:JOHNSON
Suffix:
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 1:201 SIVLEY RD SW
Mailing Address - Street 2:SUITE 530
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5134
Mailing Address - Country:US
Mailing Address - Phone:256-265-7480
Mailing Address - Fax:256-265-7481
Practice Address - Street 1:201 SIVLEY RD SW
Practice Address - Street 2:SUITE 530
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5134
Practice Address - Country:US
Practice Address - Phone:256-265-7480
Practice Address - Fax:256-265-7481
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00080232086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004070317OtherAETNA
AL51514734JOHOtherBLUE CROSS BLUE SHIELD
AL051514734Medicaid
AL511-11829OtherBCBS-AL
AL126131Medicaid
ALP00000018OtherMEDICARE RAILROAD
AL51514734JOHOtherBLUE CROSS BLUE SHIELD
C70784Medicare UPIN
AL051514734JOHMedicare ID - Type Unspecified