Individual
KIM WALDEN JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
840 PINE ST, SUITE 880, MACON, GA 31201-2100
(478) 743-7092
(478) 743-6293
Mailing address
840 PINE ST STE 880, MACON, GA 31201-7525
(478) 743-7092
(478) 743-6293
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
024443
GA
207T00000X
Neurological Surgery Physician
Primary
024443
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00358234A
—
GA
Enumeration date
06/01/2006
Last updated
01/13/2022
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