1942208954 NPI number — KIMBERLY M JOHNSON M.D.

Table of content: KIMBERLY M JOHNSON M.D. (NPI 1942208954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942208954 NPI number — KIMBERLY M JOHNSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
KIMBERLY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLAYPOOL
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942208954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 CLEVELAND ST
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
CROSSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38555-2855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-456-5814
Provider Business Mailing Address Fax Number:
931-484-8216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 CLEVELAND ST
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
CROSSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38555-2855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-456-5814
Provider Business Practice Location Address Fax Number:
931-484-8216
Provider Enumeration Date:
07/13/2005

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: 207V00000X , with the licence number:  MD0000023982 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3075326 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3005675 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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