Provider Demographics
NPI:1700840261
Name:JOHNSON, JACQUELIN MICHELLE (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELIN
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 TWIN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-6720
Mailing Address - Country:US
Mailing Address - Phone:615-370-3536
Mailing Address - Fax:
Practice Address - Street 1:21ST AVENUE SOUTH
Practice Address - Street 2:MEDICAL CENTER EAST SUITE 3200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-322-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer