Provider Demographics
NPI:1952408460
Name:JOHNSTON, BENJAMIN MAYS SR (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MAYS
Last Name:JOHNSTON
Suffix:SR
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 1:900 FIRST STREET, SUITE B
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201
Mailing Address - Country:US
Mailing Address - Phone:478-746-1717
Mailing Address - Fax:478-738-8639
Practice Address - Street 1:900 FIRST STREET, SUITE B
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-746-1717
Practice Address - Fax:478-738-8639
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018579207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00222208AMedicaid
GADD7073OtherMEDICARE RR
10BDHJRMedicare ID - Type Unspecified
D40275Medicare UPIN