Provider Demographics
NPI:1639248982
Name:JOHNSTON, DANIEL H (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:H
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2860
Mailing Address - Country:US
Mailing Address - Phone:478-475-4608
Mailing Address - Fax:478-476-8397
Practice Address - Street 1:144 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2860
Practice Address - Country:US
Practice Address - Phone:478-475-4608
Practice Address - Fax:478-476-8397
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000372103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA680013497OtherRAILROAD MEDICARE
GA000052566BMedicaid
GA680013497OtherRAILROAD MEDICARE
68BBFWRMedicare ID - Type Unspecified
GA68BBFWRMedicare PIN