Provider Demographics
NPI:1376978007
Name:G. WILLIAM MANIFOLD, M.D., P.C.
Entity Type:Organization
Organization Name:G. WILLIAM MANIFOLD, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MANIFOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-318-4380
Mailing Address - Street 1:PO BOX 1684
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-1684
Mailing Address - Country:US
Mailing Address - Phone:256-350-4855
Mailing Address - Fax:
Practice Address - Street 1:1208 SOMERVILLE RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4335
Practice Address - Country:US
Practice Address - Phone:256-318-4380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty