Provider Demographics
NPI:1982686846
Name:MANTO, AURELIO D (MD)
Entity Type:Individual
Prefix:
First Name:AURELIO
Middle Name:D
Last Name:MANTO
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 1:1000 COWLES CLINC WAY
Mailing Address - Street 2:STE A-200
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-5287
Mailing Address - Country:US
Mailing Address - Phone:706-923-2146
Mailing Address - Fax:706-923-2141
Practice Address - Street 1:1000 COWLES CLINC WAY STE C-300
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-5288
Practice Address - Country:US
Practice Address - Phone:067-999-9710
Practice Address - Fax:706-999-0274
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152291207RA0000X
GA63265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA414741507BMedicaid
GA414741507FMedicaid
GA414741507AMedicaid
MAJ18071OtherBCBS
MA3167208Medicaid
MA3167208Medicaid
GA202I116219Medicare PIN
G46469Medicare UPIN
MAA22508Medicare PIN
GA414741507AMedicaid