Provider Demographics
NPI:1174501878
Name:JOHNSON, ALEX RAY (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:RAY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 916
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-0916
Mailing Address - Country:US
Mailing Address - Phone:931-589-2104
Mailing Address - Fax:931-589-2513
Practice Address - Street 1:115 E BROOKLYN ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-3515
Practice Address - Country:US
Practice Address - Phone:931-589-2104
Practice Address - Fax:931-589-2513
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000000833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3302678Medicare ID - Type Unspecified
TNE81584Medicare UPIN