Provider Demographics
NPI:1184719379
Name:JOHNSON, HENRY GOODWIN (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:GOODWIN
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 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:334-747-4159
Mailing Address - Fax:
Practice Address - Street 1:2055 E SOUTH BLVD STE 806
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2007
Practice Address - Country:US
Practice Address - Phone:334-288-3400
Practice Address - Fax:334-288-0188
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10551207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL202207Medicaid
ALC7846OtherVIVA HEALTH
ALP01873131OtherRR MEDICARE
AL201274Medicaid
AL000011009Medicaid
AL102I167972OtherMEDICARE
AL1549806OtherCIGNA
AL200580Medicaid
ALC74846Medicare UPIN
AL202207Medicaid