1174604169 NPI number — DR. PHILIP A JOHNSON PH.D.

Table of content: DR. PHILIP A JOHNSON PH.D. (NPI 1174604169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174604169 NPI number — DR. PHILIP A JOHNSON PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
PHILIP
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174604169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 MARKET ST
Provider Second Line Business Mailing Address:
SUITE 305-B
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37402-1226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-778-9455
Provider Business Mailing Address Fax Number:
423-267-2146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 305-B
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37402-1226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-778-9455
Provider Business Practice Location Address Fax Number:
423-267-2146
Provider Enumeration Date:
10/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  P - 547 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC2200X , with the licence number: P - 547 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TB0200X , with the licence number: P - 547 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: P - 547 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TH0100X , with the licence number: P - 547 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0043707 . This is a "BCBST PROVIDER NO." identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".