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Organization

MOBILE GASTROENTEROLOGY, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHARLES EDWARD JOHNSON M.D. (PHYSICIAN AND CEO)
(251) 639-2101
Entity
Organization

Contact information

Practice address
6701 AIRPORT BLVD, SUITE A-208, MOBILE, AL 36608-6705
(251) 639-2101
(251) 639-9122
Mailing address
PO BOX 850489, MOBILE, AL 36685-0489
(251) 639-2101
(251) 639-9122

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
I960
MEDICARE GROUP PROVIDER
Enumeration date
08/14/2006
Last updated
10/18/2007
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