Provider Demographics
NPI:1043250327
Name:JOHNSTON, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WINDSWEEP CT
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36870-2336
Mailing Address - Country:US
Mailing Address - Phone:334-297-5555
Mailing Address - Fax:334-297-5525
Practice Address - Street 1:7 WINDSWEEP CT
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36870-2336
Practice Address - Country:US
Practice Address - Phone:334-297-5555
Practice Address - Fax:334-297-5525
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022796207Q00000X
AL9782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51016536OtherBLUECROSS OF ALABAMA
AL000016536Medicaid
GA00253118CMedicaid
GA1100149501Medicare ID - Type UnspecifiedPALMETTA MEDICARE