Provider Demographics
NPI:1275582405
Name:MANN, JAMES MOSS (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MOSS
Last Name:MANN
Suffix:
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 1:2739 LAUREL ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2028
Mailing Address - Country:US
Mailing Address - Phone:803-799-4800
Mailing Address - Fax:803-252-0052
Practice Address - Street 1:2739 LAUREL ST STE 1A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2028
Practice Address - Country:US
Practice Address - Phone:803-799-4800
Practice Address - Fax:803-252-0052
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25723207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCI25448Medicare ID - Type UnspecifiedAS OF 7/1/06
SCI25448Medicare UPIN