Provider Demographics
NPI:1679969729
Name:JOHNSTON, JEFFREY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:THOMAS
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 MADISON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3403
Mailing Address - Country:US
Mailing Address - Phone:901-448-5914
Mailing Address - Fax:
Practice Address - Street 1:910 MADISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3403
Practice Address - Country:US
Practice Address - Phone:901-448-5914
Practice Address - Fax:901-448-7306
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000000002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery