MEDICARE: JOHNSON FAMILY MEDICINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	14809	TN
2	207Q00000X	Family Medicine Physician	30511	TN

General Provider Information

NPI Number	:	1629446125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON FAMILY MEDICINE LLC

Provider Business Mailing Address
First Line	:	137 OBRIEN DR STE 101
Second Line	:
City	:	CROSSVILLE
State	:	TN
Zip	:	38555-8751
Country	:	US
Telephone Number	:	931-484-2220
Fax Number	:	931-484-2225

Provider Business Practice Location Address
First Line	:	137 OBRIEN DR STE 101
Second Line	:
City	:	CROSSVILLE
State	:	TN
Zip	:	38555-8751
Country	:	US
Telephone Number	:	931-484-2220
Fax Number	:	931-484-2220

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	ANGEL SUZANNE MYRICK
Credential	:
Telephone Number	:	931-484-2220

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	06/05/2026

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Directions to “JOHNSON FAMILY MEDICINE LLC ” Practice Location

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