Organization
BENJAMIN MAYS JOHNSTON, SR, M.D.
Active
Parent organization
BENJAMIN M. JOHNSTON, JR, M.D.
Organization subpart
Yes
Provider details
NPI number
Legal business name
BENJAMIN M. JOHNSTON, JR, M.D.
Authorized official
TAMMY J BRICKLE (BILLING AGENT)
(478) 254-5943
Entity
Organization
Contact information
Practice address
900 FIRST STREET, SUITE B, MACON, GA 31201-6806
(478) 746-1717
(478) 738-8639
Mailing address
PO BOX 28170, MACON, GA 31221-8170
(478) 254-5943
(478) 254-6093
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
018579
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD7073
MEDICARE RAILROAD
GA
01
—
DD7073
RAILROAD MEDICARE
—
Enumeration date
10/17/2006
Last updated
07/28/2010
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