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General NPI Number Information
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NPI Number | 1942888961
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Entity Type | Individual
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Provider Name | CHARLES GRANT JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 391 WALLACE RD
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City | NASHVILLE
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State | TN
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Zip | 37211-4851
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Country | US
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Telephone | 615-781-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 491 SAGE RD N STE 200
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City | WHITE HOUSE
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State | TN
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Zip | 37188-9361
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Country | US
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Telephone | 615-672-7122
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 71990
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License Number State | TN
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