Provider Demographics
NPI:1982674164
Name:JOHNSON, BENJAMIN W JR (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:W
Last Name:JOHNSON
Suffix:JR
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 1:1326 PAPERMILL POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1903
Mailing Address - Country:US
Mailing Address - Phone:865-673-5000
Mailing Address - Fax:865-888-9486
Practice Address - Street 1:1342 PAPERMILL POINTE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1903
Practice Address - Country:US
Practice Address - Phone:865-673-5000
Practice Address - Fax:865-588-5711
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21653207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511721Medicaid
TN103I095719Medicare PIN
TNC64930Medicare UPIN
TN1511721Medicaid