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NPI Code Detail

MEDICARE: DR. JAMIE SMITH JOHNSTON PH.D.

MEDICARE: DR. JAMIE SMITH JOHNSTON PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPY 8403FL

General Provider Information

NPI Number : 1689958142
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMIE SMITH JOHNSTON PH.D.
Provider Business Mailing Address
First Line : 187 BROOKS ST SE UNIT B602
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32548-3740
Country : US
Telephone Number : 850-362-8787
Fax Number :
Provider Business Practice Location Address
First Line : 1008 AIRPORT RD STE D
Second Line :
City : DESTIN
State : FL
Zip : 32541-2822
Country : US
Telephone Number : 850-362-8787
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2011
Last Update Date : 10/03/2011

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