Provider Demographics
NPI:1174550644
Name:JOHNSON, LAWRENCE F (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:F
Last Name:JOHNSON
Suffix:
Gender:M
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL1945DP207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100008264OtherRAILROAD MEDICARE
AL051106403OtherBLUE CROSS
MS05228358Medicaid
AL106445Medicaid
AL891009100Medicaid
AL051066287OtherBLUE CROSS
AL051595164OtherBLUE CROSS
AL051525674OtherBLUE CROSS
AL119906Medicaid
AL000036853OtherBLUE CROSS
AL000036853Medicaid
AL000084040OtherBLUE CROSS
AL051510527OtherBLUE CROSS
AL000084040Medicaid
ALG27225OtherVIVA
AL119906Medicaid
AL106445Medicaid
AL891009100Medicaid