Provider Demographics
NPI:1720285182
Name:JOHNSON-PICH, KRISTY DAWN (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:DAWN
Last Name:JOHNSON-PICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KRISTY
Other - Middle Name:DAWN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1928
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-1928
Mailing Address - Country:US
Mailing Address - Phone:334-793-8111
Mailing Address - Fax:334-793-8992
Practice Address - Street 1:1108 ROSS CLARK CIR
Practice Address - Street 2:PALLIATIVE CARE OFFICE
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3022
Practice Address - Country:US
Practice Address - Phone:334-793-8111
Practice Address - Fax:334-793-8992
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRNUO1655207R00000X
AL001139208M00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist