MEDICARE: DR. RHONDA CHARLENE JOHNSON M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	053565	GA
2	2080A0000X	Pediatric Adolescent Medicine Physician	37230	TN

General Provider Information

NPI Number	:	1104878164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RHONDA CHARLENE JOHNSON M.D

Provider Business Mailing Address
First Line	:	877 JEFFERSON AVE
Second Line	:	5TH FLOOR ADAMS PAVILION
City	:	MEMPHIS
State	:	TN
Zip	:	38103-2807
Country	:	US
Telephone Number	:	901-515-4529
Fax Number	:	901-515-4599

Provider Business Practice Location Address
First Line	:	2574 FRAYSER BLVD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38127-5829
Country	:	US
Telephone Number	:	901-515-5300
Fax Number	:	901-515-5390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	10/17/2025

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