Provider Demographics
NPI:1184252348
Name:JOHNSON, CATHY JOANNE
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:JOANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 GARY ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-4229
Mailing Address - Country:US
Mailing Address - Phone:423-790-0538
Mailing Address - Fax:423-790-0568
Practice Address - Street 1:3505 ADKISSON DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-6803
Practice Address - Country:US
Practice Address - Phone:423-790-0568
Practice Address - Fax:423-790-0568
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100000000261243747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant