Provider Demographics
NPI:1396096152
Name:JOHNSTON, SHARON GIBSON (NMD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:GIBSON
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8864
Mailing Address - Country:US
Mailing Address - Phone:678-493-2597
Mailing Address - Fax:678-492-2598
Practice Address - Street 1:1480 HICKORY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8864
Practice Address - Country:US
Practice Address - Phone:678-493-2597
Practice Address - Fax:678-492-2598
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNAT1000288175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath