Healthcare Provider Details

I. General information

NPI: 1073383535
Provider Name (Legal Business Name): PETER J JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HOSPITAL DR
MADISON TN
37115-5030
US

IV. Provider business mailing address

315 HOSPITAL DR
MADISON TN
37115-5030
US

V. Phone/Fax

Practice location:
  • Phone: 615-732-7662
  • Fax:
Mailing address:
  • Phone: 615-732-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number251727
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: