Healthcare Provider Details

I. General information

NPI: 1619691698
Provider Name (Legal Business Name): TEAM JOHNSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 PARK AVE
MEMPHIS TN
38119-5200
US

IV. Provider business mailing address

PO BOX 382504
GERMANTOWN TN
38183-2504
US

V. Phone/Fax

Practice location:
  • Phone: 901-844-1431
  • Fax:
Mailing address:
  • Phone: 901-844-1431
  • Fax: 901-844-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DARREN L JOHNSON
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 731-445-6999