Healthcare Provider Details

I. General information

NPI: 1376034298
Provider Name (Legal Business Name): MARY CARLETON JOHNSTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2018
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE B321
MOBILE AL
36608-6703
US

IV. Provider business mailing address

6701 AIRPORT BLVD STE B321
MOBILE AL
36608-6703
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-0793
  • Fax: 251-633-0736
Mailing address:
  • Phone: 251-633-0793
  • Fax: 251-633-0736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number44776
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: