Provider Demographics
NPI:1225191463
Name:JOHNSTON, TRUDI BRATTEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRUDI
Middle Name:BRATTEN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2799 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2517
Mailing Address - Country:US
Mailing Address - Phone:660-621-0171
Mailing Address - Fax:
Practice Address - Street 1:2799 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2517
Practice Address - Country:US
Practice Address - Phone:660-621-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1262103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist