Individual
MR. LARRY G JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1104 TUSCULUM BLVD, SUITE 303, GREENEVILLE, TN 37745-4091
(423) 636-8600
(423) 636-8892
Mailing address
1104 TUSCULUM BLVD, SUITE 303, GREENEVILLE, TN 37745-4091
(423) 636-8600
(423) 636-8892
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN0000030838
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0177990
BCBS OF TN
TN
05
—
3600909
—
TN
01
—
8050485
NC MEDICAID
TN
Enumeration date
04/08/2006
Last updated
08/13/2008
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