Individual provider Active NPI

Tiara Alivia Johnson, PA-C

  • Medical Physician Assistant
  • Cordova, TN
National Provider Identifier
1154217909
Registry record updated Jan 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
6859 Issued in TN
Practice address
1645 N Germantown Pkwy
Cordova, TN 38016-5962
Phone
(901) 825-5360
Fax
(901) 825-5361
NPI assigned
Jun 17, 2025
Last updated
Jan 21, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 6859 TN Primary

Addresses

Primary practice location

1645 N Germantown Pkwy
Cordova, TN 38016-5962

Mailing address

1645 N Germantown Pkwy
Cordova, TN 38016-5962
Phone (901) 825-5360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260221000985 TN Practitioner - Physician Assistant 7517448103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hamad Ahmad MD PCGroup PAC ID 0749553816, 14 clinicians

Practice addresses (Care Compare)

4772 Navy Rd
Suite a
Millington, TN 38053-1927
Phone (901) 873-0930

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Hamad Ahmad MD PC CurrentSince Feb 10, 2026 Accepting new patients
Hamad Ahmad MD PC CurrentSince Feb 10, 2026 Accepting new patients

Locations

1645 N Germantown Pkwy
Cordova, TN 38016
Phone (901) 290-4488

4772 Navy Rd
Ste A
Millington, TN 38053
Phone (901) 873-0570

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768953600000",
    "number": "1154217909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 N GERMANTOWN PKWY",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380165962",
            "telephone_number": "901-825-5360",
            "fax_number": "901-825-5361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 N GERMANTOWN PKWY",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380165962",
            "telephone_number": "901-825-5360",
            "fax_number": "901-825-5361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TIARA",
        "middle_name": "ALIVIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-17",
        "last_updated": "2026-01-21",
        "certification_date": "2026-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "6859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordova, TN

Sources for this page

Verify at the official NPI Registry.