Healthcare Provider Details

I. General information

NPI: 1780172080
Provider Name (Legal Business Name): JASON ELI JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 07/24/2022
Certification Date: 07/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 20TH ST STE 606
KNOXVILLE TN
37916-1863
US

IV. Provider business mailing address

1510 CAROWINDS CIR
MARYVILLE TN
37803-6783
US

V. Phone/Fax

Practice location:
  • Phone: 865-218-7011
  • Fax:
Mailing address:
  • Phone: 601-984-5914
  • Fax: 601-984-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number65532
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: