Provider Demographics
NPI:1912278680
Name:JOHNSON, LIJI L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LIJI
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:CREDENTIALS DEPT
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5905
Mailing Address - Country:US
Mailing Address - Phone:901-260-8551
Mailing Address - Fax:901-260-8590
Practice Address - Street 1:1211 UNION AVE
Practice Address - Street 2:STE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6638
Practice Address - Country:US
Practice Address - Phone:901-271-0330
Practice Address - Fax:901-271-0399
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2013-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA055329363A00000X
PAOA002781363A00000X
TN2383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant