Healthcare Provider Details

I. General information

NPI: 1033293535
Provider Name (Legal Business Name): LISA H JOHNSTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 N DECATUR RD STE 450
DECATUR GA
30033-6146
US

IV. Provider business mailing address

2665 N DECATUR RD STE 450
DECATUR GA
30033-6146
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-7555
  • Fax: 404-501-7550
Mailing address:
  • Phone: 404-501-7555
  • Fax: 404-501-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number043221
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number043221
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: