Healthcare Provider Details

I. General information

NPI: 1689856361
Provider Name (Legal Business Name): DAWN M MARSALA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 NORTHPOINT CIR
ALPHARETTA GA
30022-4854
US

IV. Provider business mailing address

3100 COMMONWEALTH WAY
ALPHARETTA GA
30004-4263
US

V. Phone/Fax

Practice location:
  • Phone: 770-667-8060
  • Fax: 770-667-2024
Mailing address:
  • Phone: 404-451-5980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1641
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: