Provider Demographics
NPI:1770866147
Name:MANOS, MICHAEL GEORGE (BS PH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GEORGE
Last Name:MANOS
Suffix:
Gender:M
Credentials:BS PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5963 SPOUT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-3452
Mailing Address - Country:US
Mailing Address - Phone:770-965-2371
Mailing Address - Fax:770-965-7330
Practice Address - Street 1:5963 SPOUT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3452
Practice Address - Country:US
Practice Address - Phone:770-965-2371
Practice Address - Fax:770-965-7330
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist