Healthcare Provider Details

I. General information

NPI: 1184118051
Provider Name (Legal Business Name): JOHN ROBERT JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/06/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MEDICAL CIR
NASHVILLE AR
71852-8606
US

IV. Provider business mailing address

1915 MT PLEASANT DR
NASHVILLE AR
71852
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-4400
  • Fax:
Mailing address:
  • Phone: 501-827-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-19585
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-19585
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-19585
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: