MEDICARE: DR. SCOTT R 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	207QS0010X	Sports Medicine (Family Medicine) Physician	MD46687	TN
2	207Q00000X	Family Medicine Physician	MD46687	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

General Provider Information

NPI Number	:	1780638007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT R JOHNSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38302-0400
Country	:	US
Telephone Number	:	731-425-5752
Fax Number	:	731-256-7634

Provider Business Practice Location Address
First Line	:	2859 HIGHWAY 45 BYP
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3618
Country	:	US
Telephone Number	:	731-660-8360
Fax Number	:	731-660-8377

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	12/15/2025

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