Provider Demographics
NPI:1952305567
Name:JOHNSTON, WORD M (MD)
Entity Type:Individual
Prefix:DR
First Name:WORD
Middle Name:M
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 1:603 S MAIN ST
Mailing Address - Street 2:BOX 1107
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:MS
Mailing Address - Zip Code:39119-8902
Mailing Address - Country:US
Mailing Address - Phone:601-797-3405
Mailing Address - Fax:601-797-9842
Practice Address - Street 1:603 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:MS
Practice Address - Zip Code:39119-1107
Practice Address - Country:US
Practice Address - Phone:601-797-3405
Practice Address - Fax:601-797-9842
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019242Medicaid
AJ1230022OtherDEA
B30248Medicare UPIN
MS00019242Medicaid