Provider Demographics
NPI:1619308103
Name:MANNING, MALLORY (MHS, PA-C)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 DAVIS GROVE CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-2581
Mailing Address - Country:US
Mailing Address - Phone:919-436-3777
Mailing Address - Fax:919-267-4302
Practice Address - Street 1:204 DAVIS GROVE CIR STE 103
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-2581
Practice Address - Country:US
Practice Address - Phone:919-436-3777
Practice Address - Fax:919-267-4302
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant