MEDICARE: KELLI ELIZABETH JOHNSTON D.O.

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	208000000X	Pediatrics Physician	927	SC

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

General Provider Information

NPI Number	:	1689797268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI ELIZABETH JOHNSTON D.O.

Provider Business Mailing Address
First Line	:	2911 WATERLEAF RD
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-3176
Country	:	US
Telephone Number	:	843-894-3490
Fax Number	:

Provider Business Practice Location Address
First Line	:	3312 MAYBANK HWY STE B
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-4818
Country	:	US
Telephone Number	:	843-894-3490
Fax Number	:	833-450-6022

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	05/28/2026

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