Provider Demographics
NPI:1669979985
Name:MCKENZIE, JOHNNY MILLER (MD)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:MILLER
Last Name:MCKENZIE
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 1:155 WEATHERLY WAY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2801
Mailing Address - Country:US
Mailing Address - Phone:601-303-2358
Mailing Address - Fax:
Practice Address - Street 1:817 PRINCETON AVE SW STE 106
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1340
Practice Address - Country:US
Practice Address - Phone:205-783-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.38448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine