1992039770 NPI number — TIFFANY M JOHNSON DPT

Table of content: TIFFANY M JOHNSON DPT (NPI 1992039770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992039770 NPI number — TIFFANY M JOHNSON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
TIFFANY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992039770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1267 ENTERPRISE WAY NW STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35806-4472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-713-1872
Provider Business Mailing Address Fax Number:
256-713-1873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 HUGHES RD
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35758-8999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-461-9654
Provider Business Practice Location Address Fax Number:
256-461-9728
Provider Enumeration Date:
09/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  8499 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PTH5807 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51109605 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 0446631 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051112329 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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