Healthcare Provider Details

I. General information

NPI: 1073578456
Provider Name (Legal Business Name): AMY E JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY JOHNSON MD

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 HIGHWAY 45 BYP
JACKSON TN
38305-3618
US

IV. Provider business mailing address

PO BOX 400
JACKSON TN
38302-0400
US

V. Phone/Fax

Practice location:
  • Phone: 731-422-0213
  • Fax: 731-660-8369
Mailing address:
  • Phone: 731-422-0213
  • Fax: 731-422-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49323
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberDR.0049323
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberINPROCESS
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD63332
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: