Provider Demographics
NPI:1700985793
Name:JOHNSON, AMY M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:515 STONECREST PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6826
Mailing Address - Country:US
Mailing Address - Phone:615-625-7112
Mailing Address - Fax:615-625-7028
Practice Address - Street 1:310 25TH AVE N
Practice Address - Street 2:STE 204
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1515
Practice Address - Country:US
Practice Address - Phone:615-620-5151
Practice Address - Fax:615-620-5155
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC038363A00000X
KYPA985363A00000X
TN1922363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522269Medicaid