Basic Information
| Provider Information | |||||||||
| NPI: | 1558532234 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JOHNSON | ||||||||
| FirstName: | EARL | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4000 | ||||||||
| Address2: | AUDIOLOGY-126 | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376844000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
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| Practice Location | |||||||||
| Address1: | DOGWOOD AVE | ||||||||
| Address2: | BLDG 204 AUDIOLOGY-126 | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376844000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2008 | ||||||||
| LastUpdateDate: | 05/17/2013 | ||||||||
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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 | 231H00000X | 7980 | NC | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 1388 | TN | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.