Johnson, Larry G

Johnson, Larry G is an individual health care provider with primary practice located at 1104 Tusculum Blvd Suite 303, Greeneville TN 37745-4091. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Johnson, Larry G can be contacted via phone (423) 636-8600.

Contact Information

Primary practice address
1104 Tusculum Blvd Suite 303 Greeneville TN 37745-4091
Phone: (423) 636-8600
Fax: (423) 636-8892
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X RN0000030838 Tennessee

Profile Details

NPI number 1407819725
LBN Legal business name Johnson, Larry G
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 8th, 2006
Last updated Aug 13th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407819725 NPPES
Tennessee Other 8050485 NC MEDICAID
Tennessee Other 0177990 NC MEDICAID
Tennessee MEDICAID 3600909 NC MEDICAID

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