MEDICARE: JENNA-LYN 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	390200000X	Student in an Organized Health Care Education/Training Program	0116028086	VA
2	207RC0000X	Cardiovascular Disease Physician	85677	SC

General Provider Information

NPI Number	:	1861879744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA-LYN JOHNSON MD

Provider Business Mailing Address
First Line	:	1924 ALCOA HWY # U114
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1511
Country	:	US
Telephone Number	:	865-305-6324
Fax Number	:	865-305-6429

Provider Business Practice Location Address
First Line	:	111 HIGHWAY 70 E STE G
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2080
Country	:	US
Telephone Number	:	803-744-4900
Fax Number	:	803-744-4935

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

Provider Enumeration Date	:	04/30/2015
Last Update Date	:	02/05/2026

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