MEDICARE: MRS. DOROTHY E JOHNSON PA-C

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	363A00000X	Physician Assistant	527	TN

General Provider Information

NPI Number	:	1972634178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOROTHY E JOHNSON PA-C

Provider Business Mailing Address
First Line	:	1701 SHEILA ANN DR
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3296
Country	:	US
Telephone Number	:	615-773-0607
Fax Number	:	615-228-1269

Provider Business Practice Location Address
First Line	:	3917 GALLATIN PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37216-2405
Country	:	US
Telephone Number	:	615-228-1269
Fax Number	:	615-228-1269

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/09/2007

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