MEDICARE: MICHELLE M JOHNSON DDSMS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS0000004811	TN

General Provider Information

NPI Number	:	1891856274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE M JOHNSON DDSMS

Provider Business Mailing Address
First Line	:	6551 STAGE OAKS DR
Second Line	:	SUITE 2
City	:	BARTLETT
State	:	TN
Zip	:	38134-3895
Country	:	US
Telephone Number	:	901-386-5800
Fax Number	:	901-386-9604

Provider Business Practice Location Address
First Line	:	6551 STAGE OAKS DR
Second Line	:	SUITE 2
City	:	BARTLETT
State	:	TN
Zip	:	38134-3895
Country	:	US
Telephone Number	:	901-386-5800
Fax Number	:	901-386-9604

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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