Provider Demographics
NPI:1548200793
Name:JOHNSTON, JANICE W (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:W
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 COLLIER RD NW
Mailing Address - Street 2:100-A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1709
Mailing Address - Country:US
Mailing Address - Phone:404-352-1235
Mailing Address - Fax:404-605-8805
Practice Address - Street 1:275 COLLIER RD NW
Practice Address - Street 2:100-A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1709
Practice Address - Country:US
Practice Address - Phone:404-352-1235
Practice Address - Fax:404-605-8805
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21407174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE54622Medicare UPIN