Provider Demographics
NPI:1942407572
Name:JOHNSON, AMY AMEND (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:AMEND
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ANN
Other - Last Name:AMEND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7208
Mailing Address - Country:US
Mailing Address - Phone:214-648-9012
Mailing Address - Fax:214-648-2087
Practice Address - Street 1:5939 HARRY HINES BLVD FLOOR 8, SUITE 124
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8889
Practice Address - Country:US
Practice Address - Phone:214-645-8650
Practice Address - Fax:214-645-8669
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5023207RG0300X, 207QA0505X, 207RG0300X, 207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00816306OtherRAILROAD
TX8L21066Medicare PIN