Provider Demographics
NPI:1801931001
Name:JOHNSON, MATTHEW YOUNG (PA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:YOUNG
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 22ND STREET SOUTH SUITE 1000
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8007
Mailing Address - Country:US
Mailing Address - Phone:205-715-5943
Mailing Address - Fax:205-715-5932
Practice Address - Street 1:831 1ST ST N
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8944
Practice Address - Country:US
Practice Address - Phone:205-620-1085
Practice Address - Fax:205-620-1091
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.509363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51005353OtherBLUE CROSS
AL009942984Medicaid