Provider Demographics
NPI:1558342915
Name:MANLEY, EMMETT S (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMETT
Middle Name:S
Last Name:MANLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:120 HOSPITAL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5287
Practice Address - Country:US
Practice Address - Phone:865-475-4742
Practice Address - Fax:865-262-0100
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-09-27
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Provider Licenses
StateLicense IDTaxonomies
TNMD 18208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1301085758Medicare PIN
A99268Medicare UPIN