Individual
BRUCE DEWAYNE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
142 W 5TH ST, COOKEVILLE, TN 38501-1760
(931) 528-2541
(530) 243-0445
Mailing address
1092 SUGARHILL PL, COOKEVILLE, TN 38501-4538
(931) 261-7399
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD0000040859
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3338289
—
TN
Enumeration date
05/26/2006
Last updated
07/10/2015
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