Healthcare Provider Details

I. General information

NPI: 1174637003
Provider Name (Legal Business Name): BRIAN D JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E THIRD ST
CHATTANOOGA TN
37403-2147
US

IV. Provider business mailing address

PO BOX 2930
INDIANAPOLIS IN
46206-2930
US

V. Phone/Fax

Practice location:
  • Phone: 423-602-8400
  • Fax: 423-602-8401
Mailing address:
  • Phone: 844-468-9496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD20995
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number040424
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.053100
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: