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Deactivated NPI 1396063418 Deactivated / Inactive NPI Male Practitioner

Dr. Jack Simpson Johnson , MD

General Practice • Cookeville, TN

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Jack Johnson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date May 13, 2010
NPI Deactivation Date May 18, 2020
Total Practice Duration ~10 Years of Practice (2010 – 2020)

Professional Overview & Biography Verified Profile Summary

Dr. Jack Johnson, MD was a registered General Practice practicing in Cookeville, TN. Throughout an active medical career spanning 10 years, Dr. Johnson provided care at the practice location at 979 MT. VERNON RD. until profile deactivation on 2020-05-18.

Practice Location & Contact Primary Location

Practice Address

979 Mt. Vernon Rd.

Cookeville, TN 38501

Telephone 9315266895

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Cookeville, TN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 44.3 Yrs
State Avg: 34.2 Yrs
Regional Practice Density
8 Specialists

Practicing in Cookeville, TN (202 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License TN TN0002073

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated May 18, 2020

Record deactivated on May 18, 2020

NPI Profile Active May 13, 2010

NPI status registered as active in NPPES database

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Updated Practice Location May 13, 2010

Registered at 979 MT. VERNON RD., COOKEVILLE, TN 38501 (Tel: 9315266895)

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Updated Business Mailing Address May 13, 2010

Registered at 979 MT. VERNON RD., COOKEVILLE, TN 38501 (Tel: 9315266895)

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Provider Name / Credentials Updated May 13, 2010

Recorded as JACK JOHNSON, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) May 13, 2010

General Practice (License #TN0002073 in TN)

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Initial NPI Registration & Enumeration May 13, 2010

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1396063418
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 13, 2010
Last Update: May 13, 2010
Deactivation Date: May 18, 2020

Mailing Address

979 Mt. Vernon Rd.

Cookeville, TN 38501

Phone: 9315266895

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.