Individual
DR. BRUCE SAMUEL JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
901 W GREENWOOD ST, SUITE 9, ABBEVILLE, SC 29620-5678
(864) 366-9681
(864) 366-5600
Mailing address
901 W GREENWOOD ST, SUITE 9, ABBEVILLE, SC 29620-5678
(864) 366-9681
(864) 366-5600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8390
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080172913
RAILROAD MEDICARE
SC
01
—
576000003
TAX ID
SC
05
—
RHC210
—
SC
Enumeration date
07/26/2005
Last updated
03/07/2023
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