Provider Demographics
NPI:1699893339
Name:JOHNSON, DAVID WARREN (MS, CCC-A)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WARREN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21083 EMPEROR PHILLIPS LN
Mailing Address - Street 2:
Mailing Address - City:SILVERHILL
Mailing Address - State:AL
Mailing Address - Zip Code:36576-3353
Mailing Address - Country:US
Mailing Address - Phone:251-945-1076
Mailing Address - Fax:
Practice Address - Street 1:21083 EMPEROR PHILLIPS LN
Practice Address - Street 2:
Practice Address - City:SILVERHILL
Practice Address - State:AL
Practice Address - Zip Code:36576-3353
Practice Address - Country:US
Practice Address - Phone:251-945-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0915A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2187OtherCERTIFIED HEARING AID DIS
MN08065JOOtherBLUE CROSS BLUE SHIELD PR
MN5088OtherREGISTERED AUDIOLOGIST