Provider Demographics
NPI:1669884011
Name:JOHNSON, DELORES
Entity type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DELORES
Other - Middle Name:
Other - Last Name:HERD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1760-50TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35208
Mailing Address - Country:US
Mailing Address - Phone:205-925-8624
Mailing Address - Fax:
Practice Address - Street 1:1760-50TH STREET WEST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35208
Practice Address - Country:US
Practice Address - Phone:205-925-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management