Provider Demographics
NPI:1013441815
Name:JOHNSON COMPREHENSIVE MEDICINE
Entity Type:Organization
Organization Name:JOHNSON COMPREHENSIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:901-623-4766
Mailing Address - Street 1:PO BOX 1766
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38027-1766
Mailing Address - Country:US
Mailing Address - Phone:901-623-4766
Mailing Address - Fax:
Practice Address - Street 1:461 TUSCUMBIA CV W
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3659
Practice Address - Country:US
Practice Address - Phone:901-623-4766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN15921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty