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General NPI Number Information
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NPI Number | 1457769978
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Entity Type | Individual
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Provider Name | JOSHUA BRENT JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 2341 MCCALLIE AVE STE 402
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3231
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Country | US
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Telephone | 423-698-3309
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Fax |
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Provider Business Mailing Address
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Address Line | 255 ACORN OAKS CIR APT 341
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City | CHATTANOOGA
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State | TN
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Zip | 37405-2088
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Country | US
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Telephone | 812-480-1427
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 186662
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APN19125T
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 28181730A
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License Number State | IN
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