Basic Information
| Provider Information | |||||||||
| NPI: | 1316988595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | FRANK | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2253 CHAMBLISS AVE NW | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373113861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234725423 | ||||||||
| FaxNumber: | 4234765523 | ||||||||
| Practice Location | |||||||||
| Address1: | 2253 CHAMBLISS AVE NW | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373113861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234725423 | ||||||||
| FaxNumber: | 4234765523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD006513 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3159889 | 05 | TN | MEDICAID | 2001355 | 01 | TN | BCBST | OTHER |