Individual
MICHAEL D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
410 N STATE OF FRANKLIN RD, SUITE 120, JOHNSON CITY, TN 37604-6971
(423) 975-2350
(423) 975-2372
Mailing address
410 N STATE OF FRANKLIN RD, SUITE 120, JOHNSON CITY, TN 37604-6971
(423) 975-2350
(423) 975-2372
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
940
TN
363A00000X
Physician Assistant
Primary
940
TN
363AS0400X
Surgical Physician Assistant
940
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1519882
—
TN
05
—
1699787721
—
VA
01
—
P01038739
RAILROAD MEDICARE
TN
Enumeration date
08/13/2006
Last updated
02/10/2017
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