Provider Demographics
NPI:1669486817
Name:JOHNSTON, JAMES L (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JIMMIE
Other - Middle Name:LEE
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3033 STATE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3614
Mailing Address - Country:US
Mailing Address - Phone:330-928-6780
Mailing Address - Fax:330-928-6785
Practice Address - Street 1:3033 STATE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3614
Practice Address - Country:US
Practice Address - Phone:330-928-6780
Practice Address - Fax:330-928-6785
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34001553J207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054524Medicaid
OHD89883Medicare UPIN
OH0054524Medicaid