Provider Demographics
NPI:1629070131
Name:MANFREDI, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:MANFREDI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:678-288-9555
Mailing Address - Fax:678-288-9556
Practice Address - Street 1:308 DEEP SOUTH FARM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-2218
Practice Address - Country:US
Practice Address - Phone:706-835-2235
Practice Address - Fax:706-835-1706
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2015-04-09
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Provider Licenses
StateLicense IDTaxonomies
GA16101207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000011382KMedicaid
GA000011382MMedicaid
GAD45999Medicare UPIN
GA000011382MMedicaid