Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 41119 | TN |
N | 207PP0204X | Pediatric Emergency Physician | 41119 | TN |
N | 2080P0204X | Pediatric Emergency Doctor | 022289 | LA |
N | 2080P0204X | Pediatric Emergency Doctor | 19184 | AL |
NPI | 1487698361 |
---|---|
Provider Name | Michael Nolen Johnston |
First Address | Nashville, TN 37232-0001 |
Second Address | Nashville, TN 37232-4700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 19/10/2020 |