Provider Demographics
NPI:1033182522
Name:JOHNSON, LINDA LOU (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOU
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:615-314-5257
Mailing Address - Fax:615-692-0547
Practice Address - Street 1:1501 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6636
Practice Address - Country:US
Practice Address - Phone:725-269-7001
Practice Address - Fax:725-269-7003
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504171Medicaid
NVP01724670OtherRAILROAD MEDICARE
NVFN533ZMedicare PIN
NVP01724670OtherRAILROAD MEDICARE
NV40408Medicare PIN