MEDICARE: DR. SAMUEL T JOHNSON SR. MD

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	207Q00000X	Family Medicine Physician	MD11374	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	141592	OTHER		BETTER HEALTH UNISON
3	268267	OTHER	TN	UNISON ADVANTAGE
4	4309182	OTHER	TN	BCBSTN INDIVIDUAL
5	3017954	OTHER	TN	CIGNA
6	27017	OTHER	TN	TLC
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	4063363	OTHER	TN	BCROSS
9	4229920	OTHER	TN	BCBSTN
10	4909218	OTHER	TN	BCBCTN GROUP

General Provider Information

NPI Number	:	1457304131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL T JOHNSON SR. MD

Provider Business Mailing Address
First Line	:	PO BOX 507
Second Line	:
City	:	COVINGTON
State	:	TN
Zip	:	38019-0507
Country	:	US
Telephone Number	:	901-475-4752
Fax Number	:	901-475-1554

Provider Business Practice Location Address
First Line	:	4235 HIGHWAY 51 S
Second Line	:
City	:	BRIGHTON
State	:	TN
Zip	:	38011-6921
Country	:	US
Telephone Number	:	901-475-4752
Fax Number	:	901-475-1554

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/29/2026

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