Healthcare Provider Details

I. General information

NPI: 1992062855
Provider Name (Legal Business Name): PAUL JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVENUE, 2 SHORB TOWER
MEMPHIS TN
38104-2030
US

IV. Provider business mailing address

1211 UNION AVE STE 330
MEMPHIS TN
38104-6655
US

V. Phone/Fax

Practice location:
  • Phone: 901-478-0900
  • Fax: 901-266-6415
Mailing address:
  • Phone: 901-478-0954
  • Fax: 901-478-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME138979
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number64847
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME138979
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number64847
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: