| Doctor Name: | MRS. MARILYN BALL JOHNSON |
| NPI Number: | 1033121660 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LDO |
| License Number: | LDO0000845 |
| Business Practice Address: | 1805 E Walnut Ave Dalton, GA - 307214338 |
| Business Phone Number: | 7062781252 |
| Business Fax Number: | 7062792062 |
| Mailing Address: | 1805 E Walnut Ave, DALTON |
| State: | GA |
| Postal Code: | 307214338 |
| Phone Number: | 7062781252 |
| Fax Number: | 7062792062 |
| NPI Enumeration Date: | 08/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | LDO0000845 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |