Healthcare Provider Details

I. General information

NPI: 1912030610
Provider Name (Legal Business Name): ROY NEIL JOHNSTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 MEDLOCK RD
DECATUR GA
30030-1515
US

IV. Provider business mailing address

PO BOX 666
DECATUR GA
30031-0666
US

V. Phone/Fax

Practice location:
  • Phone: 404-378-0330
  • Fax: 404-378-2191
Mailing address:
  • Phone: 404-378-0330
  • Fax: 404-378-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number040428
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number040428
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: