Individual
MR. CHASE ALEXANDER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
165 PANTHER DR APT 232, CUMBERLAND GAP, TN 37724-4725
(423) 765-6756
Mailing address
165 PANTHER DR APT 232, CUMBERLAND GAP, TN 37724-4725
(423) 765-6756
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
119420385
ATHLETIC TRAINER
TN
Enumeration date
02/12/2019
Last updated
02/12/2019
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