Provider Demographics
NPI:1033164827
Name:MANLEY, PHILIP EDWARD JR (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:EDWARD
Last Name:MANLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:890 S PLEASANTBURG DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2455
Practice Address - Country:US
Practice Address - Phone:864-271-1450
Practice Address - Fax:864-271-3914
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20331208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC203318Medicaid
SC576007863032OtherBCBS OF SC
SC370019021OtherRR MEDICARE
SC576007863103OtherBLUE CHOICE OF SC
SC7172301OtherAETNA
SC1416332OtherCIGNA
SCG41167Medicare UPIN
SC576007863032OtherBCBS OF SC