Provider Demographics
NPI:1871593160
Name:JOHNSTON, RICHARD B III (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:JOHNSTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3035
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-0917
Practice Address - Country:US
Practice Address - Phone:404-352-1015
Practice Address - Fax:404-477-1176
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033606207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000656631HMedicaid
GA000656631GMedicaid
GA200045072OtherRAILROAD MEDICARE
GA000656631IMedicaid
GA000656631IMedicaid
GA000656631GMedicaid