Provider Demographics
NPI:1922080316
Name:MANN, JOHN E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:MANN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2106
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-2106
Mailing Address - Country:US
Mailing Address - Phone:601-703-4282
Mailing Address - Fax:601-703-3080
Practice Address - Street 1:1106 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-8972
Practice Address - Country:US
Practice Address - Phone:601-656-6921
Practice Address - Fax:601-656-0381
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS05295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080121055OtherRAILROAD MEDICARE
MS00110589Medicaid
MS288056YJ8JOtherMEDICARE
MS00110589Medicaid