Provider Demographics
NPI:1316459829
Name:GERALD E JOHNSON MD PLLC
Entity type:Organization
Organization Name:GERALD E JOHNSON MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RN/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-498-3870
Mailing Address - Street 1:6142 SHALLOWFORD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7216
Mailing Address - Country:US
Mailing Address - Phone:423-498-3300
Mailing Address - Fax:423-498-3301
Practice Address - Street 1:6142 SHALLOWFORD RD STE 103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7216
Practice Address - Country:US
Practice Address - Phone:423-498-3300
Practice Address - Fax:423-498-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN322482080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty