Provider Demographics
NPI:1255351110
Name:JOHNSTON, SCOTT RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RICHARD
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HUFF DRIVE
Mailing Address - Street 2:JOHNSTON PAIN MANAGEMENT, P.A.
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7325
Mailing Address - Country:US
Mailing Address - Phone:910-353-4414
Mailing Address - Fax:910-353-2972
Practice Address - Street 1:250 HUFF DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7369
Practice Address - Country:US
Practice Address - Phone:910-353-4414
Practice Address - Fax:910-353-2972
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34999208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1255351110OtherRAILROAD MEDICARE
NCG01491Medicare UPIN
NC050046340Medicare PIN