Provider Demographics
NPI:1356923296
Name:JOHNSON, BENJAMIN ERIC
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ERIC
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 23RD AVE S STE 3105
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3196
Mailing Address - Country:US
Mailing Address - Phone:615-327-7119
Mailing Address - Fax:615-327-7136
Practice Address - Street 1:1601 23RD AVE S STE 3105
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3196
Practice Address - Country:US
Practice Address - Phone:615-327-7119
Practice Address - Fax:615-327-7136
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program