| Doctor Name: | AMELIA M JOHNSON |
| NPI Number: | 1023099512 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPO |
| License Number: | DPO1192 |
| Business Practice Address: | 25 N Main St Suite A Sparta, TN - 385832055 |
| Business Phone Number: | 9318362235 |
| Business Fax Number: | 9318363036 |
| Mailing Address: | 25 N Main St, Suite A SPARTA |
| State: | TN |
| Postal Code: | 385832055 |
| Phone Number: | 9318362235 |
| Fax Number: | 9318363036 |
| NPI Enumeration Date: | 11/10/2005 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | DPO1192 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |