Provider Demographics
NPI:1073263026
Name:JOHNSTON, NATHANAEL YOUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANAEL
Middle Name:YOUNG
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 1:2451 UNIVERSITY HOSPITAL DR RM 714
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617-2300
Mailing Address - Country:US
Mailing Address - Phone:215-434-3915
Mailing Address - Fax:215-415-1387
Practice Address - Street 1:2451 UNIVERSITY HOSPITAL DR RM 714
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2300
Practice Address - Country:US
Practice Address - Phone:215-434-3915
Practice Address - Fax:215-415-1387
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.5668208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics