Provider Demographics
NPI:1972634178
Name:JOHNSON, DOROTHY E (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SHEILA ANN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3296
Mailing Address - Country:US
Mailing Address - Phone:615-773-0607
Mailing Address - Fax:615-228-1269
Practice Address - Street 1:3917 GALLATIN PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-2405
Practice Address - Country:US
Practice Address - Phone:615-228-1269
Practice Address - Fax:615-228-1269
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN527363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP03339Medicare UPIN