Individual
STACY ALANA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D., PH.D.
Contact information
Practice address
1325 EASTMORELAND AVE, SUITE 220, MEMPHIS, TN 38104-3519
(901) 448-5227
Mailing address
1325 EASTMORELAND AVE, SUITE 220, MEMPHIS, TN 38104-3519
(901) 448-5227
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
158299
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003180105A
—
GA
05
—
04171535
—
MS
05
—
191144
—
AL
05
—
1912131236
—
MO
05
—
225514001
—
AR
05
—
Q022744
—
TN
Enumeration date
05/14/2009
Last updated
10/08/2018
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