Provider Demographics
NPI:1144691650
Name:MANN, GREGORY TYLER (CSFA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:TYLER
Last Name:MANN
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LIBERTY HILL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-9215
Mailing Address - Country:US
Mailing Address - Phone:270-250-1256
Mailing Address - Fax:
Practice Address - Street 1:200 LIBERTY HILL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-9215
Practice Address - Country:US
Practice Address - Phone:270-250-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant