Individual
GEORGE 'BRICK' RETER JOHNSTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
115 BUSINESS LOOP 70 W, COLUMBIA, MO 65203-3244
(573) 882-1561
(573) 884-1889
Mailing address
2020 PEACHTREE RD NW, ATLANTA, GA 30309-1426
(404) 367-1208
(404) 603-4441
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY004549
GA
103TC0700X
Clinical Psychologist
PYR0266
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131610
HEALTHLINK
MO
01
—
13644
BLUE SHIELD/BLUE CHOICE
MO
05
—
493401103
—
MO
01
—
6145989
UNITED HEALTHCARE
MO
01
—
680002939
RR MEDICARE
MO
Enumeration date
05/18/2006
Last updated
02/03/2022
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