Provider Demographics
NPI:1265430557
Name:JOHNSON, THOMAS LP (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LP
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 1:2700 10TH AVE S
Mailing Address - Street 2:STE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1248
Mailing Address - Country:US
Mailing Address - Phone:205-933-7838
Mailing Address - Fax:205-933-0951
Practice Address - Street 1:2700 10TH AVE S
Practice Address - Street 2:STE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1248
Practice Address - Country:US
Practice Address - Phone:205-933-7838
Practice Address - Fax:205-933-0951
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11097207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G18152Medicare UPIN
AL51511T00Medicare ID - Type Unspecified