Healthcare Provider Details

I. General information

NPI: 1669162673
Provider Name (Legal Business Name): WILLIAM TRASK JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MADISON AVE STE 447
MEMPHIS TN
38103-3438
US

IV. Provider business mailing address

50 N DUNLAP ST
MEMPHIS TN
38103-2800
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-5265
  • Fax: 901-287-5062
Mailing address:
  • Phone: 901-287-5265
  • Fax: 901-287-5062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number77450
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: