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General NPI Number Information
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NPI Number | 1528020120
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Entity Type | Individual
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Provider Name | JAROLD THOMAS JOHNSTON JR. CNM, IBCLC
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Gender | Male
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | WOMACK ARMY MEDICAL CENTER
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City | FORT BRAGG
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State | NC
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Zip | 28310-0001
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Country | US
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Telephone | 910-907-6920
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Fax | 910-907-6920
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Provider Business Mailing Address
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Address Line | 130 MAZAK CT
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City | FORT BRAGG
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State | NC
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Zip | 28307-2512
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Country | US
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Telephone | 910-213-4405
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Fax | 910-907-6920
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 115019
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License Number State | TN
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