Provider Demographics
NPI:1659451805
Name:VICTORIA D MANNING
Entity Type:Organization
Organization Name:VICTORIA D MANNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-868-3330
Mailing Address - Street 1:6420 POLLARDS POND RD
Mailing Address - Street 2:
Mailing Address - City:APPLING
Mailing Address - State:GA
Mailing Address - Zip Code:30802-3726
Mailing Address - Country:US
Mailing Address - Phone:706-868-3330
Mailing Address - Fax:706-868-3336
Practice Address - Street 1:6420 POLLARDS POND RD
Practice Address - Street 2:
Practice Address - City:APPLING
Practice Address - State:GA
Practice Address - Zip Code:30802-3726
Practice Address - Country:US
Practice Address - Phone:706-868-3330
Practice Address - Fax:706-868-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN052799305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization