Healthcare Provider Details

I. General information

NPI: 1023578267
Provider Name (Legal Business Name): REBECCA JOHNSON AGNER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANN JOHNSON

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S PETERS ROAD SUITE 105
KNOXVILLE TN
37923
US

IV. Provider business mailing address

PO BOX 15004
KNOXVILLE TN
37901-5004
US

V. Phone/Fax

Practice location:
  • Phone: 865-470-8844
  • Fax: 866-479-4403
Mailing address:
  • Phone: 865-541-8895
  • Fax: 865-633-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number5654
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5654
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: