Provider Demographics
NPI:1497893556
Name:JOHNSON, ERNEST KAYE III (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:KAYE
Last Name:JOHNSON
Suffix:III
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 1:1705 WINDOVER DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37218-2410
Mailing Address - Country:US
Mailing Address - Phone:615-276-4825
Mailing Address - Fax:
Practice Address - Street 1:1705 WINDOVER DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37218-2410
Practice Address - Country:US
Practice Address - Phone:615-276-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10912208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10912OtherSTATE LICENSE NUMBER
TN10912OtherSTATE LICENSE NUMBER
TNB59413Medicare UPIN