Provider Demographics
NPI:1134134901
Name:MANOUGIAN, SHERI KLINGENBERG (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:KLINGENBERG
Last Name:MANOUGIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 GEORGETOWN SQ
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6205
Mailing Address - Country:US
Mailing Address - Phone:678-514-2108
Mailing Address - Fax:678-514-2104
Practice Address - Street 1:4370 GEORGETOWN SQ
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6205
Practice Address - Country:US
Practice Address - Phone:678-514-2108
Practice Address - Fax:678-514-2104
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002636363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001798AMedicaid
GA100001798AMedicaid