Provider Demographics
NPI:1346200516
Name:MANY, WICKLIFFE J JR (MD)
Entity Type:Individual
Prefix:
First Name:WICKLIFFE
Middle Name:J
Last Name:MANY
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 1:2900 MCGEHEE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2151
Mailing Address - Country:US
Mailing Address - Phone:334-280-3349
Mailing Address - Fax:334-356-1426
Practice Address - Street 1:2055 E SOUTH BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116
Practice Address - Country:US
Practice Address - Phone:334-284-5211
Practice Address - Fax:334-284-9020
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00006677207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000014514Medicaid
AL051014514OtherBCBS OF AL
636005396005OtherHUMANA GOLD CHOICE MEDICARE
636005396005OtherHUMANA GOLD CHOICE MEDICARE
AL000014514Medicaid
AL051014514OtherBCBS OF AL