Provider Demographics
NPI:1639186455
Name:JOHNSTON, CHERI CONLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERI
Middle Name:CONLEY
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 1:10810 PARKSIDE DRIVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934
Mailing Address - Country:US
Mailing Address - Phone:865-647-3650
Mailing Address - Fax:865-647-3659
Practice Address - Street 1:10810 PARKSIDE DR STE 108
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1980
Practice Address - Country:US
Practice Address - Phone:865-647-3650
Practice Address - Fax:865-647-3659
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD017443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513775Medicaid
TN1513775Medicaid
TN4065722OtherAETNA-JOHNSTON
TN4088725OtherMEDICARE ID-TYPE UNSPECIFIED
TNA98680Medicare UPIN