Healthcare Provider Details

I. General information

NPI: 1174501878
Provider Name (Legal Business Name): ALEX RAY JOHNSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E BROOKLYN ST
LINDEN TN
37096-3515
US

IV. Provider business mailing address

PO BOX 916
LINDEN TN
37096-0916
US

V. Phone/Fax

Practice location:
  • Phone: 931-589-2104
  • Fax: 931-589-2513
Mailing address:
  • Phone: 931-589-2104
  • Fax: 931-589-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO0000000833
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: