Provider Demographics
NPI:1467169540
Name:VERNERETTE, MANEL II (PA)
Entity Type:Individual
Prefix:
First Name:MANEL
Middle Name:
Last Name:VERNERETTE
Suffix:II
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 ROSWELL RD APT B3
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2264
Mailing Address - Country:US
Mailing Address - Phone:305-414-9522
Mailing Address - Fax:
Practice Address - Street 1:6900 ROSWELL RD APT B3
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-2264
Practice Address - Country:US
Practice Address - Phone:305-414-9522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant