Provider Demographics
NPI:1427662451
Name:JOHNSTON, AMBER LENEE (RPSGT)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:LENEE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:MRS
Other - First Name:AMBER
Other - Middle Name:LENEE
Other - Last Name:WAYNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPSGT
Mailing Address - Street 1:31 BERRYHILL PL SE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-3200
Mailing Address - Country:US
Mailing Address - Phone:404-444-2453
Mailing Address - Fax:770-644-1759
Practice Address - Street 1:2540 WINDY HILL RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8605
Practice Address - Country:US
Practice Address - Phone:770-644-1774
Practice Address - Fax:770-644-1759
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
8188246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other