MEDICARE: MARK W JOHNSON 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	029781	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00351984	OTHER	TN	RR MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679571715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK W JOHNSON MD

Provider Business Mailing Address
First Line	:	1275 DICK LONAS RD UNIT 101
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1383
Country	:	US
Telephone Number	:	865-584-4747
Fax Number	:	865-584-1363

Provider Business Practice Location Address
First Line	:	2125 W EMORY RD
Second Line	:
City	:	POWELL
State	:	TN
Zip	:	37849-3704
Country	:	US
Telephone Number	:	865-938-7517
Fax Number	:	865-938-1067

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	04/27/2020

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Directions to “ MARK W JOHNSON MD” Practice Location

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