Provider Demographics
NPI:1851357578
Name:JOHNSON, JAMES S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:JOHNSON
Suffix:
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 1:1720 WEST AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4066
Mailing Address - Country:US
Mailing Address - Phone:931-484-2220
Mailing Address - Fax:931-484-2225
Practice Address - Street 1:4147 HIGHWAY 127 N STE 102
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38571-7521
Practice Address - Country:US
Practice Address - Phone:931-484-2220
Practice Address - Fax:931-484-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3806366Medicaid
G63820Medicare UPIN
TN3806366Medicaid