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General NPI Number Information
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NPI Number | 1053785154
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Entity Type | Organization
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Legal Business Name | JOHNSON ORTHOPAEDIC, LLC
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 11/30/2015
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Provider Practice Location Address
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Address Line | 5100 POPLAR AVE SUITE 720
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City | MEMPHIS
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State | TN
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Zip | 38137-4000
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Country | US
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Telephone | 901-570-6198
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Fax |
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Provider Business Mailing Address
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Address Line | 1945 PRESTWICK DR
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City | GERMANTOWN
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State | TN
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Zip | 38139-3451
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOE JOHNSON
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Credential |
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Telephone | 901-570-6198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 0627937
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License Number State | TN
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