Provider Demographics
NPI:1124007984
Name:JOHNSON, MARSHALL R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:R
Last Name:JOHNSON
Suffix:JR
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 1:355 NEW SHACKLE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2300
Mailing Address - Country:US
Mailing Address - Phone:615-338-1000
Mailing Address - Fax:615-338-1101
Practice Address - Street 1:355 NEW SHACKLE ISLAND RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2300
Practice Address - Country:US
Practice Address - Phone:615-338-1000
Practice Address - Fax:615-338-1101
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37449207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3884900Medicaid
TN3884900Medicaid
TNG54505Medicare UPIN
TN3884900Medicare PIN