Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | P - 547 | TN |
Y | 103G00000X | Clinical Psychologist | P - 547 | TN |
Y | 103TC0700X | Clinical Psychologist | P - 547 | TN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | P - 547 | TN |
N | 103TH0100X | Health Service | P - 547 | TN |
NPI | 1174604169 |
---|---|
Provider Name | Dr. Philip A Johnson |
First Address | Chattanooga, TN 37402-1226 |
Second Address | Chattanooga, TN 37402-1226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 17/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0043707 | BCBST PROVIDER NO. (01) | TN |