Basic Information
| Provider Information | |||||||||
| NPI: | 1821032673 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHNSTON NEUROLOGY, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16127 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275166127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664575293 | ||||||||
| FaxNumber: | 9199676647 | ||||||||
| Practice Location | |||||||||
| Address1: | 11618 US HIGHWAY 70 W | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275202275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195502501 | ||||||||
| FaxNumber: | 9199676647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 07/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | GILANI | ||||||||
| AuthorizedOfficialFirstName: | AJMAL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8664575293 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
ID Information
| ID | Type | State | Issuer | Description | 131T0 | 01 | NC | BCBS NC | OTHER | 5904155 | 05 | NC | MEDICAID |