Provider Demographics
NPI:1821309592
Name:MANK, GERALD WAYNE III (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WAYNE
Last Name:MANK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2209 S STERLING ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4093
Mailing Address - Country:US
Mailing Address - Phone:828-580-6752
Mailing Address - Fax:828-580-6754
Practice Address - Street 1:2209 S STERLING ST STE 200
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4093
Practice Address - Country:US
Practice Address - Phone:828-580-6752
Practice Address - Fax:828-580-6754
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1755207R00000X, 207RG0100X
NC2017-02526207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821309592Medicaid