Provider Demographics
NPI:1891791596
Name:MANNING, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:MANNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 EXCHANGE PL SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6723
Mailing Address - Country:US
Mailing Address - Phone:770-922-3522
Mailing Address - Fax:770-922-3662
Practice Address - Street 1:2215 EXCHANGE PL SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6723
Practice Address - Country:US
Practice Address - Phone:770-922-3522
Practice Address - Fax:770-922-3662
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0106242OtherUNITED HEALTHCARE
GA00431747CMedicaid
GA582361278OtherFEDERAL TAX ID
GA005301OtherCIGNA HEALTHCARE
GA4119030001OtherMEDICARE DME
GA5124OtherKAISER PERMANENTE
GA080119233OtherRAILROAD RETIREMENT MEDIC
GA08BDMNQMedicare ID - Type Unspecified
GA00431747CMedicaid