Ellory Kate Johnson, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

1167 Issued in AL

Practice address

535 Jack Warner Pkwy NE Ste G2
Tuscaloosa, AL 35404-5715

Phone

(205) 771-2261

NPI assigned

May 23, 2023

Last updated

May 23, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mentorup Life Lab & Clinic

  • General Practice Physician
  • Tuscaloosa, AL
  • NPI 1063104511
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1467144949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 20TH ST NE",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354041502",
            "telephone_number": "205-771-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 JACK WARNER PKWY NE STE G2",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354045715",
            "telephone_number": "205-771-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ELLORY",
        "middle_name": "KATE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-23",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AL",
            "license": "1167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johnson CRF LLC
• Charles E Johnson Jr., DMD
• Chase Johnson
• Colleen Ruth Johnson, PT
• Dawn L Johnson, O.D.
• Ernest Van Johnson, M.D.
• Ianswer Johnson, MPH, CHES
• Jacquelyne Johnson, LICSW,PIP
• Jamie Devon Johnson, DMD
• Keniece Johnson

• General Practice Physician in Tuscaloosa, AL
• Providers in Tuscaloosa, AL by specialty
• General Practice Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.