Provider Demographics
NPI:1962685628
Name:APANAY, MANOLO BUNAG (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOLO
Middle Name:BUNAG
Last Name:APANAY
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 1:4604 TIGER LILY WAY NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-3643
Mailing Address - Country:US
Mailing Address - Phone:770-321-1770
Mailing Address - Fax:770-321-1919
Practice Address - Street 1:4604 TIGER LILY WAY NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-3643
Practice Address - Country:US
Practice Address - Phone:770-321-1770
Practice Address - Fax:770-321-1919
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13575174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD28803Medicare UPIN