Provider Demographics
NPI:1639118102
Name:MANN, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 TILGHMAN DR STE A
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4958
Mailing Address - Country:US
Mailing Address - Phone:910-892-6500
Mailing Address - Fax:910-892-1766
Practice Address - Street 1:801 TILGHMAN DR STE A
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4958
Practice Address - Country:US
Practice Address - Phone:910-892-6500
Practice Address - Fax:910-892-1766
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20417208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC62308OtherCIGNA
NC87726OtherUNITED HEALTHCARE
NC34097OtherMEDCOST
NC52148OtherMAMSI
NC53886OtherBLUE CROSS BLUE SHIELD
NC010020861OtherPALMETTO GBA RAILROAD
NC153074000OtherUS DEPT OF LABOR
NC8953886Medicaid
NCC80961Medicare UPIN
201907Medicare ID - Type Unspecified