Provider Demographics
NPI:1942208954
Name:JOHNSON, KIMBERLY M (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:CLAYPOOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:49 CLEVELAND ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-2855
Mailing Address - Country:US
Mailing Address - Phone:931-456-5814
Mailing Address - Fax:931-484-8216
Practice Address - Street 1:49 CLEVELAND ST
Practice Address - Street 2:SUITE 240
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-2855
Practice Address - Country:US
Practice Address - Phone:931-456-5814
Practice Address - Fax:931-484-8216
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000023982207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3075326Medicaid
TN3005675OtherBLUE CROSS BLUE SHIELD
F56322Medicare UPIN
TN3075326Medicaid