Provider Demographics
NPI:1790759850
Name:JOHNSTON, GINA A (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:A
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:PO BOX 1483
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1483
Mailing Address - Country:US
Mailing Address - Phone:662-470-1110
Mailing Address - Fax:317-705-5060
Practice Address - Street 1:7550 WOLF RIVER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1778
Practice Address - Country:US
Practice Address - Phone:901-542-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28387207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3880737Medicaid
AR149765001Medicaid
TN3880737Medicaid
AR5M373C278Medicare PIN
TN3880737Medicare PIN