Johnson, Clancy Hagedorn
Johnson, Clancy Hagedorn is an sole proprietor health care provider with primary practice located at 1300 Bridge Creek Dr. Ne Suite A, Cullman AL 35055. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Dermatopathology, Allopathic & Osteopathic Physicians / Procedural Dermatology. Allopathic & Osteopathic Physicians / Dermatology is her primary health care specialty. Johnson, Clancy Hagedorn can be contacted via phone (256) 737-7546.Contact Information
Primary practice address
1300 Bridge Creek Dr. Ne Suite A
Cullman AL 35055
Phone: (256) 737-7546
Fax: (256) 841-6180
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 0027325 | Alabama |
| Allopathic & Osteopathic Physicians / Dermatopathology | 207ND0900X | 00027325 | Alabama |
| Allopathic & Osteopathic Physicians / Procedural Dermatology | 207NS0135X | 00027325 | Alabama |
Profile Details
| NPI number | 1275591315 |
|---|---|
| LBN Legal business name | Johnson, Clancy Hagedorn |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 1st, 2006 |
| Last updated | May 16th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275591315 | NPPES |
| Other | P00390029 | MEDICARE RAILROAD CARRIER PTAN | |
| MEDICAID | 009937754 | MEDICARE RAILROAD CARRIER PTAN | |
| Other | 051557589 | MEDICARE RAILROAD CARRIER PTAN | |
| Other | CC9291 | MEDICARE RAILROAD CARRIER PTAN |
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