Provider Demographics
NPI:1003801143
Name:JOHNSON, ROBERT M (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 PATTERSON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1551
Mailing Address - Country:US
Mailing Address - Phone:615-340-4611
Mailing Address - Fax:615-340-4658
Practice Address - Street 1:2410 PATTERSON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1551
Practice Address - Country:US
Practice Address - Phone:615-340-4611
Practice Address - Fax:615-340-4658
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000004294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3145441Medicaid
KY4294Medicaid
TN3145443Medicare ID - Type Unspecified
KY4294Medicaid