MEDICARE: CAROLYN M JOHNSTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	4301056679	MI
2	207VX0201X	Gynecologic Oncology Physician	4301056679	MI
3	207VX0201X	Gynecologic Oncology Physician	277897	MA
4	207VX0201X	Gynecologic Oncology Physician	ME144006	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417040544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN M JOHNSTON MD

Provider Business Mailing Address
First Line	:	211 AVENUE G
Second Line	:
City	:	APALACHICOLA
State	:	FL
Zip	:	32320-1576
Country	:	US
Telephone Number	:	734-936-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 ONE HEALING PL
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4600
Country	:	US
Telephone Number	:	850-431-5360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/11/2020

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Directions to “ CAROLYN M JOHNSTON MD” Practice Location

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