Provider Demographics
NPI:1316988595
Name:JOHNSON, WILLIAM FRANK II (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FRANK
Last Name:JOHNSON
Suffix:II
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 1:2253 CHAMBLISS AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3861
Mailing Address - Country:US
Mailing Address - Phone:423-472-5423
Mailing Address - Fax:423-476-5523
Practice Address - Street 1:2253 CHAMBLISS AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3861
Practice Address - Country:US
Practice Address - Phone:423-472-5423
Practice Address - Fax:423-476-5523
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD006513208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3159889Medicaid
TN2001355OtherBCBST
B59998Medicare UPIN
TN3159889Medicaid