Provider Demographics
NPI:1306814801
Name:JOHNSTON, JOHN W JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:JOHNSTON
Suffix:JR
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:PO BOX 5392
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5392
Mailing Address - Country:US
Mailing Address - Phone:601-703-4926
Mailing Address - Fax:601-703-4928
Practice Address - Street 1:1314 19TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4116
Practice Address - Country:US
Practice Address - Phone:601-703-4926
Practice Address - Fax:601-703-4928
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14986207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00292073OtherRR MEDICARE
MS168390702OtherUS DEPT OF LABOR
MS753068151OtherMS HEALTH PARTNERS
MS753068151Other1ST CHOICE
MS753068151008OtherTRICARE
MS770143OtherAETNA
MS00121566Medicaid
MS753068151OtherMS PHYSICIANS CARE NETWOR
MS753068151OtherMS HEALTH PARTNERS
MS00121566Medicaid