Provider Demographics
NPI:1972572923
Name:JOHNSTON, MATTHEW M (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:M
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:418 EH CT
Mailing Address - Street 2:UNIT 4B
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2199
Mailing Address - Country:US
Mailing Address - Phone:912-267-0884
Mailing Address - Fax:912-267-7948
Practice Address - Street 1:418 EH CT
Practice Address - Street 2:UNIT 4B
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-2199
Practice Address - Country:US
Practice Address - Phone:912-267-0884
Practice Address - Fax:912-267-7948
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA030109207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD84785Medicare UPIN
GA16BDBFGMedicare ID - Type Unspecified