Provider Demographics
NPI:1811974926
Name:JOHNSON, DAVID BRYAN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRYAN
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 1:3310 WEST END AVE 590
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1260
Mailing Address - Country:US
Mailing Address - Phone:615-913-5086
Mailing Address - Fax:888-494-2588
Practice Address - Street 1:4411 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-2367
Practice Address - Country:US
Practice Address - Phone:423-892-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0102830OtherUNITED HEALTHCARE
GA841074OtherBLUE CROSS BLUE SHIELD
GA000905121COtherMEDICAID GA
NC89064FNOtherMEDICAID NC
GAP00048268OtherRAILROAD MEDICARE
GA0102830OtherUNITED HEALTHCARE
GA08BBWVNMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
NC89064FNOtherMEDICAID NC