Provider Demographics
NPI:1528020120
Name:JOHNSTON, JAROLD THOMAS JR (CNM, IBCLC)
Entity Type:Individual
Prefix:MR
First Name:JAROLD
Middle Name:THOMAS
Last Name:JOHNSTON
Suffix:JR
Gender:M
Credentials:CNM, IBCLC
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Mailing Address - Street 1:130 MAZAK CT
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28307-2512
Mailing Address - Country:US
Mailing Address - Phone:910-213-4405
Mailing Address - Fax:910-907-6920
Practice Address - Street 1:WOMACK ARMY MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-6920
Practice Address - Fax:910-907-6920
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TN115019367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife