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General NPI Number Information
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NPI Number | 1437316106
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Entity Type | Individual
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Provider Name | OLIVIA MARIE GRANILLO JOHNSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 1224 TROTWOOD AVE
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City | COLUMBIA
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State | TN
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Zip | 38401-4802
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Country | US
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Telephone | 931-380-4072
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 MEDICAL CENTER PKWY
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City | MURFREESBORO
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State | TN
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Zip | 37129-2245
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Country | US
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Telephone | 615-396-4694
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Fax | 615-396-3751
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 48469
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 48469
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License Number State | TN
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