Individual
JOHNATHAN MILTON ISOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MBA
Contact information
Practice address
5744 NANJACK CIR, MEMPHIS, TN 38115-2061
(901) 797-9711
(901) 797-9771
Mailing address
PO BOX 400, JACKSON, TN 38302-0400
(731) 425-5752
(731) 422-5743
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
20634
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302I059810
MEDICARE PTAN
MS
01
—
3030932
BCBS
TN
Enumeration date
04/26/2006
Last updated
12/20/2018
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