Provider Demographics
NPI:1679511596
Name:JOHNSTON PSYCHIATRIC ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:JOHNSTON PSYCHIATRIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ABU-SALHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-550-3323
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-0187
Mailing Address - Country:US
Mailing Address - Phone:919-550-3323
Mailing Address - Fax:919-550-3379
Practice Address - Street 1:2076 NC HIGHWAY 42 W
Practice Address - Street 2:SUITE 220
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5302
Practice Address - Country:US
Practice Address - Phone:919-550-3323
Practice Address - Fax:919-550-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-00752174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBA5957937OtherANESTHESIA LICENSE
NC5903360Medicaid
NC1165VOtherBCBS
NC=========OtherTAX ID
NC1165VOtherBCBS
NCG88255Medicare UPIN