Provider Demographics
NPI:1588126635
Name:JOHNSON, ADAM B
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CENTURY PARK S STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3924
Mailing Address - Country:US
Mailing Address - Phone:205-942-3200
Mailing Address - Fax:205-942-0767
Practice Address - Street 1:300 CENTURY PARK S STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-3924
Practice Address - Country:US
Practice Address - Phone:205-942-3200
Practice Address - Fax:205-942-0767
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3972101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)