Provider Demographics
NPI:1942232616
Name:JOHNSON, DANNA SUZANNE (MS, ATC/L)
Entity type:Individual
Prefix:MRS
First Name:DANNA
Middle Name:SUZANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:TN
Mailing Address - Zip Code:37012-2030
Mailing Address - Country:US
Mailing Address - Phone:615-529-2795
Mailing Address - Fax:
Practice Address - Street 1:1616 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3100
Practice Address - Country:US
Practice Address - Phone:615-443-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000004412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer