Provider Demographics
NPI:1770639619
Name:JOHNSON, DAVID LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MURFREESBORO
Other - Middle Name:FAMILY
Other - Last Name:CARE, P.C.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1453 HOPE WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3140
Mailing Address - Country:US
Mailing Address - Phone:615-893-9390
Mailing Address - Fax:615-893-4162
Practice Address - Street 1:1453 HOPE WAY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3140
Practice Address - Country:US
Practice Address - Phone:615-893-9390
Practice Address - Fax:615-893-4162
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD019450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC72419Medicare UPIN
3719484Medicare ID - Type Unspecified