Provider Demographics
NPI:1245262336
Name:JOHNSON, ROBERT A (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:JOHNSON
Suffix:
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 1:7945 WOLF RIVER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-683-0055
Mailing Address - Fax:901-922-6701
Practice Address - Street 1:7945 WOLF RIVER BOULEVARD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-683-0055
Practice Address - Fax:901-922-6701
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13100207RH0003X
ARN8169207RH0003X
TN21289207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4197600OtherAETNA
AR96185OtherBCBS AR
MO203153812Medicaid
MS00015569Medicaid
AR119057001Medicaid
TN3058486Medicaid
TN4064749OtherBCBS TN
F53105Medicare UPIN
TN4064749OtherBCBS TN
MO203153812Medicaid
AR96185OtherBCBS AR
TNP00059812Medicare PIN