Basic Information
| Provider Information | |||||||||
| NPI: | 1871593160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 CIRCLE 75 PKWY SE | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303393035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709536929 | ||||||||
| FaxNumber: | 7709536972 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 HOWELL MILL RD NW STE 200 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303180917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043521015 | ||||||||
| FaxNumber: | 4044771176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 06/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 033606 | GA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 033606 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000656631H | 05 | GA | MEDICAID | 000656631G | 05 | GA | MEDICAID | 200045072 | 01 | GA | RAILROAD MEDICARE | OTHER | 000656631I | 05 | GA | MEDICAID |