Provider Demographics
NPI:1104809508
Name:JOHNSON, JOANN ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BOB WALLACE AVE SW
Mailing Address - Street 2:SUITE E
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3847
Mailing Address - Country:US
Mailing Address - Phone:256-539-5339
Mailing Address - Fax:256-536-5111
Practice Address - Street 1:101 BOB WALLACE AVE SW
Practice Address - Street 2:SUITE E
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3847
Practice Address - Country:US
Practice Address - Phone:256-539-5339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4556208000000X
ALAL4556208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51518176OtherBLUE CROSS BLUE SHIELD
AL4483860OtherAETNA
AL51010283OtherBLUE CROSS BLUE SHIELD
AL529702470Medicaid
AL1403382OtherFIRST HEALTH
AL4483860OtherAETNA