Healthcare Provider Details

I. General information

NPI: 1669486817
Provider Name (Legal Business Name): JAMES L. JOHNSTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JIMMIE LEE JOHNSTON D.O.

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 STATE RD SUITE 202
CUYAHOGA FALLS OH
44223-3614
US

IV. Provider business mailing address

3033 STATE RD SUITE 202
CUYAHOGA FALLS OH
44223-3614
US

V. Phone/Fax

Practice location:
  • Phone: 330-928-6780
  • Fax: 330-928-6785
Mailing address:
  • Phone: 330-928-6780
  • Fax: 330-928-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34001553J
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: