Provider Demographics
NPI:1467447169
Name:MANNING, SHANE NELSON (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:NELSON
Last Name:MANNING
Suffix:
Gender:M
Credentials:DPM
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Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-365-0966
Mailing Address - Fax:620-669-2394
Practice Address - Street 1:20 GLENLAKE PKWY
Practice Address - Street 2:KAISER PERMANENTE GLENLAKE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3473
Practice Address - Country:US
Practice Address - Phone:620-662-6000
Practice Address - Fax:620-669-2394
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN07001087A213ES0103X
OH36003364M213ES0103X
GAPOD001209213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2578974Medicaid
IN200952390Medicaid
OHV05172Medicare UPIN
IN058940DMedicare PIN
OHMA4158971Medicare ID - Type Unspecified