Provider Demographics
NPI:1831631670
Name:JOHNSTON, KRISTOPHER MARK HOTAI (MS, ATC)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:MARK HOTAI
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BEMISS RD
Mailing Address - Street 2:
Mailing Address - City:MOODY AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31699-0947
Mailing Address - Country:US
Mailing Address - Phone:276-276-6086
Mailing Address - Fax:
Practice Address - Street 1:BEMISS RD
Practice Address - Street 2:
Practice Address - City:MOODY AFB
Practice Address - State:GA
Practice Address - Zip Code:31699-0001
Practice Address - Country:US
Practice Address - Phone:276-608-6497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0038992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer