Healthcare Provider Details

I. General information

NPI: 1922282052
Provider Name (Legal Business Name): R NEIL JOHNSTON MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N DECATUR RD
SCOTTDALE GA
30079-1143
US

IV. Provider business mailing address

3033 NORTH DECATUR ROAD P.O. BOX 102
SCOTTDALE GA
30079-0102
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-9908
  • Fax: 404-508-9906
Mailing address:
  • Phone: 404-508-9908
  • Fax: 404-508-9906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ROY NEIL JOHNSTON
Title or Position: OWNER
Credential: MD
Phone: 404-931-8330