Provider Demographics
NPI:1699763847
Name:JOHNSTON, JAMES H (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:JOHNSTON
Suffix:
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 1:1421 N STATE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1658
Mailing Address - Country:US
Mailing Address - Phone:601-355-1234
Mailing Address - Fax:601-354-3881
Practice Address - Street 1:1421 N STATE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1658
Practice Address - Country:US
Practice Address - Phone:601-355-1234
Practice Address - Fax:601-354-3881
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08471207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115724Medicaid
MS100000020Medicare PIN
MSB31048Medicare UPIN
MS00115724Medicaid