Healthcare Provider Details

I. General information

NPI: 1194952333
Provider Name (Legal Business Name): MARY A. JOHNSTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5045 CARPENTER CREEK DR
PENSACOLA FL
32503-2521
US

IV. Provider business mailing address

2315 W JACKSON ST
PENSACOLA FL
32505-7552
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-2400
  • Fax: 850-416-2467
Mailing address:
  • Phone: 850-436-4630
  • Fax: 850-436-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME140124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: