Provider Demographics
NPI:1184880783
Name:JOHNSON, COURTNEY BONNER (MD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:BONNER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LYNN
Other - Last Name:BONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:875 W POPLAR AVE STE 23-#169
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2598
Mailing Address - Country:US
Mailing Address - Phone:901-402-0239
Mailing Address - Fax:
Practice Address - Street 1:984 SCHILLING ROW AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-1264
Practice Address - Country:US
Practice Address - Phone:901-402-0239
Practice Address - Fax:619-826-4106
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100159382084P0800X
MO20080159762084P0800X
TN00000589902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1184880783Medicaid
MO109970014Medicare Oscar/Certification