Individual
WALTER E JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1907 MISSION 66, VICKSBURG, MS 39180-3711
(601) 636-1173
Mailing address
1115 N FRONTAGE RD, VICKSBURG, MS 39180-5102
(601) 634-8790
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
07023
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00014424
—
MS
05
—
1141411
—
LA
01
—
5891536
AETNA
MS
Enumeration date
07/05/2006
Last updated
09/10/2020
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