Provider Demographics
NPI:1194899187
Name:JOHNSON, JENNIFER B (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
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 1:880 MONTCLAIR RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1972
Mailing Address - Country:US
Mailing Address - Phone:205-592-1622
Mailing Address - Fax:205-592-5653
Practice Address - Street 1:880 MONTCLAIR RD
Practice Address - Street 2:SUITE 270
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1972
Practice Address - Country:US
Practice Address - Phone:205-592-1622
Practice Address - Fax:205-592-5653
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine