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General NPI Number Information
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NPI Number | 1184880783
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Entity Type | Individual
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Provider Name | COURTNEY BONNER JOHNSON M.D
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Gender | Female
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Dates
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Enumeration Date | 08/03/2008
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 984 SCHILLING ROW AVE
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City | COLLIERVILLE
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State | TN
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Zip | 38017-1264
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Country | US
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Telephone | 901-402-0239
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Fax | 619-826-4106
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Provider Business Mailing Address
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Address Line | 875 W POPLAR AVE STE 23-#169
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City | COLLIERVILLE
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State | TN
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Zip | 38017-2598
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Country | US
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Telephone | 901-402-0239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2010015938
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2008015976
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0000058990
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License Number State | TN
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