Individual
TIMOTHY VAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
535 JACK WARNER PKWY NE, SUITE B-1, TUSCALOOSA, AL 35404-5751
(205) 556-2121
(205) 554-0152
Mailing address
535 JACK WARNER PKWY NE, SUITE B-1, TUSCALOOSA, AL 35404-5751
(205) 556-2121
(205) 554-0152
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD33294
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529202430
—
AL
Enumeration date
06/22/2010
Last updated
06/22/2020
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