Provider Demographics
NPI:1336358530
Name:MICHAEL R. JOHNSTON, D.C., P.C.
Entity Type:Organization
Organization Name:MICHAEL R. JOHNSTON, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:REU
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-272-6512
Mailing Address - Street 1:PO BOX 1836
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-1700
Mailing Address - Country:US
Mailing Address - Phone:678-272-6512
Mailing Address - Fax:678-272-6514
Practice Address - Street 1:15 JONESBORO ST # B
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3116
Practice Address - Country:US
Practice Address - Phone:678-272-6512
Practice Address - Fax:678-272-6514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJFQMedicare ID - Type Unspecified
GAU75190Medicare UPIN
GAGRP7141Medicare ID - Type Unspecified