Provider Demographics
NPI:1518975754
Name:JOHNSTON, LESTER T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:T
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 1:212 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-5619
Mailing Address - Country:US
Mailing Address - Phone:706-678-6944
Mailing Address - Fax:706-678-6945
Practice Address - Street 1:212 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-5619
Practice Address - Country:US
Practice Address - Phone:706-678-6944
Practice Address - Fax:706-678-6945
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055605207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA102740825GMedicaid
GA102740825HMedicaid
SCG55605Medicaid
GA102740825IMedicaid
GA102740825JMedicaid
GA102740825IMedicaid
GA102740825GMedicaid
GA102740825JMedicaid