MEDICARE: KAVIN J 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	207R00000X	Internal Medicine Physician	21478	TN

General Provider Information

NPI Number	:	1689673105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAVIN J JOHNSON MD

Provider Business Mailing Address
First Line	:	9029 HIWASSEE ST NW
Second Line	:
City	:	CHARLESTON
State	:	TN
Zip	:	37310-5305
Country	:	US
Telephone Number	:	423-665-9026
Fax Number	:	423-584-6747

Provider Business Practice Location Address
First Line	:	9029 HIWASSEE ST NW
Second Line	:
City	:	CHARLESTON
State	:	TN
Zip	:	37310-5305
Country	:	US
Telephone Number	:	423-665-9026
Fax Number	:	423-584-6747

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	11/25/2014

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