Provider Demographics
NPI:1902000490
Name:JOHNS, BRIAN S (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:JOHNS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2372 LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-2411
Mailing Address - Country:US
Mailing Address - Phone:615-610-1756
Mailing Address - Fax:
Practice Address - Street 1:2372 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214
Practice Address - Country:US
Practice Address - Phone:615-610-1756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1483363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200115300AMedicaid
OK246722503Medicare PIN
OK200115300AMedicaid