Provider Demographics
NPI:1104808641
Name:JOHNSON, HARRY KEITH (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:KEITH
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 CHURCH ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2990
Mailing Address - Country:US
Mailing Address - Phone:615-329-1495
Mailing Address - Fax:615-329-4450
Practice Address - Street 1:1633 CHURCH ST
Practice Address - Street 2:SUITE 160
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2990
Practice Address - Country:US
Practice Address - Phone:615-329-1495
Practice Address - Fax:615-329-4450
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7208207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN64627250Medicaid
TNB03669Medicare UPIN
TN3175004Medicare ID - Type Unspecified