Provider Demographics
NPI:1003295072
Name:MANY, JEFFREY RICHARD (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RICHARD
Last Name:MANY
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:269 GILLMAN RD
Practice Address - Street 2:STE 100
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-3007
Practice Address - Country:US
Practice Address - Phone:704-316-4930
Practice Address - Fax:704-316-4931
Is Sole Proprietor?:No
Enumeration Date:2015-05-23
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38055207Q00000X
NC2018-00652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine