Provider Demographics
NPI:1922282052
Name:R NEIL JOHNSTON MD LLC
Entity Type:Organization
Organization Name:R NEIL JOHNSTON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-931-8330
Mailing Address - Street 1:3033 NORTH DECATUR ROAD
Mailing Address - Street 2:P.O. BOX 102
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-0102
Mailing Address - Country:US
Mailing Address - Phone:404-508-9908
Mailing Address - Fax:404-508-9906
Practice Address - Street 1:3033 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:GA
Practice Address - Zip Code:30079-1143
Practice Address - Country:US
Practice Address - Phone:404-508-9908
Practice Address - Fax:404-508-9906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0404282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDGKGMedicare PIN