Individual ProviderStacy Alana JohnsonInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address1325 Eastmoreland Ave, Suite 220, Memphis, TN 38104-3519(901) 448-5227PECOS EnrollmentBased on the most recent information from CMS, provider Stacy Alana Johnson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1912131236Provider TypeIndividualFull NameJohnson, Stacy AlanaCredentialM.D., PH.D.GenderFemaleSole ProprietorYesEnumeration Date5/14/2009Last Updated10/8/2018Contact InformationPractice LocationPractice Address1325 Eastmoreland Ave, Suite 220, Memphis, TN 38104-3519Phone(901) 448-5227FaxUnlisted FaxMailing LocationMailing Address1325 Eastmoreland Ave, Suite 220, Memphis, TN 38104-3519Phone(901) 448-5227FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207RN0300XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense158299TennesseeProvider IdentifiersIDDescriptionIssuerIDQ022744DescriptionMedicaidIssuerUnlistedTennesseeID04171535DescriptionMedicaidIssuerUnlistedMississippiID003180105ADescriptionMedicaidIssuerUnlistedGeorgiaID225514001DescriptionMedicaidIssuerUnlistedArkansasID191144DescriptionMedicaidIssuerUnlistedAlabamaID1912131236DescriptionMedicaidIssuerUnlistedMissouri