Provider Demographics
NPI:1770581589
Name:JOHNSON, WILLIAM EARLE III (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EARLE
Last Name:JOHNSON
Suffix:III
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 1:1855 SPRINGHILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-2301
Mailing Address - Country:US
Mailing Address - Phone:251-471-3544
Mailing Address - Fax:251-476-7254
Practice Address - Street 1:1855 SPRINGHILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-2301
Practice Address - Country:US
Practice Address - Phone:251-471-3544
Practice Address - Fax:251-476-7254
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000127352086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000016030Medicaid
AL510-16030OtherBLUE CROSS BLUE SHIELD
C70785Medicare UPIN
AL510-16030OtherBLUE CROSS BLUE SHIELD