Healthcare Provider Details

I. General information

NPI: 1295753762
Provider Name (Legal Business Name): JAMES W JOHNSON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 PARK AVE SUITE 250
MEMPHIS TN
38119
US

IV. Provider business mailing address

PO BOX 772193
MEMPHIS TN
38177
US

V. Phone/Fax

Practice location:
  • Phone: 901-753-3766
  • Fax: 901-759-1184
Mailing address:
  • Phone: 901-761-9901
  • Fax: 901-761-9675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD0000011485
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number17134
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD0000011485
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17134
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: