Provider Demographics
NPI:1700080330
Name:JOHNSTON, C
Entity Type:Individual
Prefix:DR
First Name:C
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11844 BANDERA RD
Mailing Address - Street 2:NO. 705
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11844 BANDERA RD
Practice Address - Street 2:NO. 705
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4132
Practice Address - Country:US
Practice Address - Phone:210-695-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG88802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology