Provider Demographics
NPI:1780651877
Name:MANNING, JAMES L (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:MANNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-423-8697
Mailing Address - Fax:731-422-5743
Practice Address - Street 1:2859 HIGHWAY 45 BYP
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3618
Practice Address - Country:US
Practice Address - Phone:731-660-8360
Practice Address - Fax:731-664-7928
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD11685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3031234OtherBLUE CROSS BLUE SHIELD
TN3184767Medicaid
TN129206OtherUNISON
TN080084501OtherRAILROAD MEDICARE
TN3184760Medicaid
TN3184767Medicaid
TN080084501OtherRAILROAD MEDICARE
TN3031234OtherBLUE CROSS BLUE SHIELD