Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 32248 | TN |
N | 2080P0202X | Pediatric Cardiologist | MD0000032248 | TN |
N | 2080P0202X | Pediatric Cardiologist | MD422722 | PA |
NPI | 1194772178 |
---|---|
Provider Name | Gerald Johnson |
First Address | Chattanooga, TN 37421-6515 |
Second Address | Chattanooga, TN 37421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1008205830001 | (05) | PA |
H94270 | (02) | PA |