Provider Demographics
NPI:1790752970
Name:JOHNSON, PAUL H (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:H
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 1:629 KENESAW AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6660
Mailing Address - Country:US
Mailing Address - Phone:865-250-9420
Mailing Address - Fax:
Practice Address - Street 1:629 KENESAW AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6660
Practice Address - Country:US
Practice Address - Phone:865-250-9420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26983207XS0117X
TNMD26983207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1315364OtherUNITED HEALTH CARE
TN3071390OtherBLUE CROSS BLUE SHIELD
P00851104OtherRAILROAD MEDICARE
TN3091588Medicaid
TN4551661OtherAETNA
TNP00221434OtherRAILROAD MEDICARE
TNTN0148OtherJOHN DEERE HEALTHCARE
TN100011327OtherTENNCARE
TNTN0116OtherJOHN DEERE HEALTHCARE
TN3071390OtherBLUE CROSS BLUE SHIELD
TN3091588Medicaid
TN4551661OtherAETNA