Provider Demographics
NPI:1770644288
Name:MANNING, KELLI ANNE (ATC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ANNE
Last Name:MANNING
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CRABAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-4501
Mailing Address - Country:US
Mailing Address - Phone:706-867-1673
Mailing Address - Fax:
Practice Address - Street 1:70 ANSLEY DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1613
Practice Address - Country:US
Practice Address - Phone:706-864-7904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0007532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer