Healthcare Provider Details

I. General information

NPI: 1790752970
Provider Name (Legal Business Name): PAUL H. JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 KENESAW AVE
KNOXVILLE TN
37919-6660
US

IV. Provider business mailing address

629 KENESAW AVE
KNOXVILLE TN
37919-6660
US

V. Phone/Fax

Practice location:
  • Phone: 865-250-9420
  • Fax:
Mailing address:
  • Phone: 865-250-9420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number26983
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD26983
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: