Provider Demographics
NPI:1851778609
Name:JOHNSON, GRANT (DO)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2801 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4035
Mailing Address - Country:US
Mailing Address - Phone:615-250-9200
Mailing Address - Fax:615-250-9251
Practice Address - Street 1:300 STONECREST BLVD STE 485
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6888
Practice Address - Country:US
Practice Address - Phone:615-459-3330
Practice Address - Fax:615-459-2997
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN4082208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4082OtherSTATE LICENSE