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General NPI Number Information
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NPI Number | 1538239520
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Entity Type | Individual
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Provider Name | CHAD R. JOHNSTON MD
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 916 N WASHINGTON ST
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City | DU QUOIN
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State | IL
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Zip | 62832-1200
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Country | US
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Telephone | 618-542-2146
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Fax |
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Provider Business Mailing Address
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Address Line | 900 N WASHINGTON ST
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City | DU QUOIN
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State | IL
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Zip | 62832-1233
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Country | US
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Telephone | 618-542-2146
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Fax | 618-542-4756
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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 | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 0058849
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036119004
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A95435
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License Number State | CA
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