MEDICARE: DR. NATHAN RANEY 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	63138	TN

General Provider Information

NPI Number	:	1164956736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN RANEY JOHNSON M.D.

Provider Business Mailing Address
First Line	:	7550 WOLF RIVER BLVD STE 102
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-1779
Country	:	US
Telephone Number	:	901-767-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	7550 WOLF RIVER BLVD STE 102
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-1779
Country	:	US
Telephone Number	:	901-767-5000
Fax Number	:

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

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	11/10/2021

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