Provider Demographics
NPI:1043675861
Name:JOHNSTON, EMILY (RD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E WT HARRIS BLVD
Mailing Address - Street 2:SUITE 2122B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3485
Mailing Address - Country:US
Mailing Address - Phone:704-863-6548
Mailing Address - Fax:704-863-6321
Practice Address - Street 1:101 E WT HARRIS BLVD
Practice Address - Street 2:SUITE 2122B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-863-6548
Practice Address - Fax:704-863-6321
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered