Provider Demographics
NPI:1083652937
Name:JOHNSTON, KRISTINA SAWYER (DPT, CHT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:SAWYER
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DPT, CHT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:DYAN
Other - Last Name:SAWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:1111 LOWER FAYETTEVILLE RD
Practice Address - Street 2:STE 2000
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6501
Practice Address - Country:US
Practice Address - Phone:770-251-7284
Practice Address - Fax:770-251-7295
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBDDZMedicare ID - Type Unspecified