Provider Demographics
NPI:1912030610
Name:JOHNSTON, ROY NEIL (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:NEIL
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-0666
Mailing Address - Country:US
Mailing Address - Phone:404-378-0330
Mailing Address - Fax:404-378-2191
Practice Address - Street 1:544 MEDLOCK RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1515
Practice Address - Country:US
Practice Address - Phone:404-378-0330
Practice Address - Fax:404-378-2191
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0404282084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000763188EMedicaid
GAF68145Medicare UPIN
GA26BDGKGMedicare PIN