Healthcare Provider Details

I. General information

NPI: 1578885406
Provider Name (Legal Business Name): JOHNSTON RADIATION ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 HWY 42 W SUITE 120
CLAYTON NC
27520-5303
US

IV. Provider business mailing address

2076 HWY 42 W SUITE 120
CLAYTON NC
27520-5303
US

V. Phone/Fax

Practice location:
  • Phone: 919-585-8550
  • Fax:
Mailing address:
  • Phone: 919-585-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN CIELINSKI
Title or Position: CFO
Credential:
Phone: 919-938-6629