Individual
DR. CLANCY HAGEDORN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1300 BRIDGE CREEK DR. NE, SUITE A, CULLMAN, AL 35055
(256) 737-7546
(256) 841-6180
Mailing address
1300 BRIDGE CREEK DR. NE, SUITE A, CULLMAN, AL 35055
(256) 737-7546
(256) 841-6180
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0027325
AL
207ND0900X
Dermatopathology Physician
00027325
AL
207NS0135X
Procedural Dermatology Physician
00027325
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009937754
—
AL
01
—
051557589
BLUE CROSS BLUE SHIELD
AL
01
—
CC9291
RAILROAD MEDICARE
AL
01
—
P00390029
MEDICARE RAILROAD CARRIER PTAN
—
Enumeration date
05/01/2006
Last updated
05/16/2016
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