Provider Demographics
NPI:1942794987
Name:JOHNSON, MOLLY WILLISON (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:WILLISON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:WILLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3951 MARY ELIZA TRCE NW STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1078
Mailing Address - Country:US
Mailing Address - Phone:770-425-4001
Mailing Address - Fax:770-425-7636
Practice Address - Street 1:3951 MARY ELIZA TRCE NW STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1078
Practice Address - Country:US
Practice Address - Phone:770-425-4001
Practice Address - Fax:770-425-7636
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist