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General NPI Number Information
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NPI Number | 1679738272
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Entity Type | Individual
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Provider Name | MICHAEL FREDERICK JOHNSON P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 08/08/2011
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Provider Practice Location Address
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Address Line | 1802 N JACKSON ST
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City | TULLAHOMA
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State | TN
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Zip | 37388-8218
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Country | US
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Telephone | 931-455-4529
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Fax | 931-455-4633
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Provider Business Mailing Address
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Address Line | 1802 NORTH JACKSON STREET SUITE 8
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City | TULLAHOMA
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State | TN
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Zip | 37388
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Country | US
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Telephone | 931-455-4520
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Fax | 931-455-4633
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1564
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License Number State | TN
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