Individual
RUDOLPH GORDON JOHNSTONE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
48 CREEKVIEW CT, GREENVILLE, SC 29615-4800
(864) 458-7431
(864) 458-7463
Mailing address
DEPT 453 PO BOX 1000, MEMPHIS, TN 38148-0001
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
13617
SC
207K00000X
Allergy & Immunology Physician
Primary
MD13617
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136178
—
SC
01
—
D182976910
MEDICARE PTAN
SC
Enumeration date
10/27/2005
Last updated
10/31/2023
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