Provider Demographics
NPI:1013929520
Name:JOHNSTON, JOSHUA KENT (OD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KENT
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 TRENTWOOD PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319
Mailing Address - Country:US
Mailing Address - Phone:404-680-8474
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE STE 1500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2248
Practice Address - Country:US
Practice Address - Phone:404-897-6810
Practice Address - Fax:404-829-1319
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT13677T152W00000X
GAOPT002197152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA159565798AMedicaid
GAP001185806OtherRAILROAD MEDICARE
GA159565798AMedicaid
GA41ZCFRZMedicare ID - Type Unspecified