Provider Demographics
NPI:1427116169
Name:JOHNSTON, MICHAEL STANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STANLEY
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1112 WARRENHALL LN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1938
Mailing Address - Country:US
Mailing Address - Phone:404-459-8834
Mailing Address - Fax:
Practice Address - Street 1:2191 NORTHLAKE PKWY
Practice Address - Street 2:SUITE 1122
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4166
Practice Address - Country:US
Practice Address - Phone:678-822-5810
Practice Address - Fax:678-822-5811
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044500208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine