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General NPI Number Information
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NPI Number | 1194772178
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Entity Type | Individual
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Provider Name | GERALD JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 6142 SHALLOWFORD RD STE 103
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7216
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Country | US
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Telephone | 423-498-3300
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Fax | 423-498-3301
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Provider Business Mailing Address
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Address Line | 6142 SHALLOWFORD RD STE 103
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7216
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Country | US
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Telephone | 423-498-3300
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Fax | 423-498-3301
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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 | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | MD0000032248
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | MD422722
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 32248
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License Number State | TN
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