Provider Demographics
NPI:1790972628
Name:JOHNSTON, CHAMBLESS RAND III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAMBLESS
Middle Name:RAND
Last Name:JOHNSTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:408 N STATE OF FRANKLIN RD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6089
Mailing Address - Country:US
Mailing Address - Phone:423-431-1810
Mailing Address - Fax:423-431-1811
Practice Address - Street 1:2408 SUSANNAH ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1732
Practice Address - Country:US
Practice Address - Phone:423-434-6677
Practice Address - Fax:423-461-0000
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
TN45404207R00000X
VA0101246390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1790972628Medicaid
TN1528827Medicaid
TNP01037769OtherRR MEDICARE
VA1790972628Medicaid
TN1528827Medicaid