Healthcare Provider Details

I. General information

NPI: 1104808641
Provider Name (Legal Business Name): HARRY KEITH JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 CHURCH ST SUITE 160
NASHVILLE TN
37203-2990
US

IV. Provider business mailing address

1633 CHURCH ST SUITE 160
NASHVILLE TN
37203-2990
US

V. Phone/Fax

Practice location:
  • Phone: 615-329-1495
  • Fax: 615-329-4450
Mailing address:
  • Phone: 615-329-1495
  • Fax: 615-329-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number7208
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: