1275517732 NPI number — MS. ANGELIA HIGHTOWER JOHNSON MSPT

Table of content: MS. ANGELIA HIGHTOWER JOHNSON MSPT (NPI 1275517732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275517732 NPI number — MS. ANGELIA HIGHTOWER JOHNSON MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ANGELIA
Provider Middle Name:
HIGHTOWER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
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:
1275517732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6270A N UCHEE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATCHECHUBBEE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36858-2808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-448-3900
Provider Business Mailing Address Fax Number:
334-298-6086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1321 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHENIX CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36867-5027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-448-3900
Provider Business Practice Location Address Fax Number:
334-298-6086
Provider Enumeration Date:
11/30/2005

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:  PTH 4300 , 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)





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