Provider Demographics
NPI:1407169147
Name:LABADY-DAVIS, MANISE (DDS)
Entity Type:Individual
Prefix:
First Name:MANISE
Middle Name:
Last Name:LABADY-DAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 GOVERNORS DR STE 405
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-6101
Mailing Address - Country:US
Mailing Address - Phone:901-233-6800
Mailing Address - Fax:
Practice Address - Street 1:4930 GOVERNORS DR
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6101
Practice Address - Country:US
Practice Address - Phone:404-363-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADM015246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521957Medicaid