Provider Demographics
NPI:1386624252
Name:KEVIN JOHNSON MD PC
Entity type:Organization
Organization Name:KEVIN JOHNSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-734-9472
Mailing Address - Street 1:PO BOX 822
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-0822
Mailing Address - Country:US
Mailing Address - Phone:256-734-9472
Mailing Address - Fax:256-734-9272
Practice Address - Street 1:1403 WALL ST NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-0000
Practice Address - Country:US
Practice Address - Phone:256-734-9472
Practice Address - Fax:256-734-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty