Johnston, Kim Walden

Johnston, Kim Walden is an individual health care provider with primary practice located at 840 Pine St Suite 880, Macon GA 31201-2100. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Neurological Surgery. Allopathic & Osteopathic Physicians / Neurological Surgery is his primary health care specialty. Johnston, Kim Walden can be contacted via phone (478) 743-7092.

Contact Information

Primary practice address
840 Pine St Suite 880 Macon GA 31201-2100
Phone: (478) 743-7092
Fax: (478) 743-6293
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 024443 Georgia
Allopathic & Osteopathic Physicians / Neurological Surgery 207T00000X 024443 Georgia

Profile Details

NPI number 1417994096
LBN Legal business name Johnston, Kim Walden
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2006
Last updated Jan 13th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417994096 NPPES
Georgia MEDICAID 00358234A

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