Healthcare Provider Details

I. General information

NPI: 1104385269
Provider Name (Legal Business Name): WILLIAM NEILL JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 SKYLINE DR
JACKSON TN
38301-3911
US

IV. Provider business mailing address

257 BANCORP SOUTH PKWY
JACKSON TN
38305-7582
US

V. Phone/Fax

Practice location:
  • Phone: 731-422-7900
  • Fax:
Mailing address:
  • Phone: 731-422-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number247168
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number247168
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number247168
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: