Healthcare Provider Details

I. General information

NPI: 1942450531
Provider Name (Legal Business Name): R. NEIL JOHNSTON, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
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: 404-931-8330
  • Fax: 404-378-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number040428
License Number StateGA

VIII. Authorized Official

Name: R NEIL JOHNSTON
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 404-378-0330