Provider Demographics
NPI:1235706730
Name:JOHNSON, MARILYN M
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 PLEASANT HILL RD NW STE 113A
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2769
Mailing Address - Country:US
Mailing Address - Phone:404-437-1268
Mailing Address - Fax:
Practice Address - Street 1:465 PLEASANT HILL RD NW STE 113A
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2769
Practice Address - Country:US
Practice Address - Phone:404-437-1268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty