Dr Derek K Johnson, MD | |
300 Stonecrest Blvd Ste 250, Smyrna, TN 37167-6832 | |
(629) 220-0211 | |
(629) 220-0210 |
Full Name | Dr Derek K Johnson |
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Gender | Male |
Speciality | Pediatrics |
Location | 300 Stonecrest Blvd Ste 250, Smyrna, Tennessee |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1386603850 | NPI | - | NPPES |
001842036 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | MD073165L (Pennsylvania) | Secondary |
208000000X | Pediatrics | MD40831 (Tennessee) | Primary |
Entity Name | The Center For Pediatric Excellence, Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1386382273 PECOS PAC ID: 9234519802 Enrollment ID: O20220629002557 |
Mailing Address | Practice Location Address |
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Dr Derek K Johnson, MD 300 Stonecrest Blvd Ste 250, Smyrna, TN 37167-6832 Ph: (629) 220-0211 | Dr Derek K Johnson, MD 300 Stonecrest Blvd Ste 250, Smyrna, TN 37167-6832 Ph: (629) 220-0211 |
Dana J Haselton, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 699 President Pl, Smyrna, TN 37167 Phone: 615-459-5252 | |
Lee David Mockrin, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 515 Stonecrest Pkwy, Suite 150, Smyrna, TN 37167 Phone: 615-223-1350 Fax: 615-223-1351 | |
Rachel Ames, NP Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 537 Stonecrest Pkwy Ste 201, Smyrna, TN 37167 Phone: 615-625-0270 | |
Miss Rachel Morales Ricafort, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 739 President Pl Ste 110, Smyrna, TN 37167 Phone: 615-625-7780 Fax: 615-625-7781 | |
Dr. Catherine Sipe Bottoms, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 741 President Pl, Suite 210, Smyrna, TN 37167 Phone: 615-223-5565 Fax: 615-223-5509 | |
Dr. Mitali Nanda, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 515 Stonecrest Pkwy, Suite 150, Smyrna, TN 37167 Phone: 615-223-1550 Fax: 615-223-1331 | |
Melissa Emily Fuller, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 741 President Place, Suite 210, Smyrna, TN 37167 Phone: 615-223-5565 Fax: 615-223-5509 |