Provider Demographics
NPI:1295976926
Name:MANNINGS, JUAN (RSA)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:MANNINGS
Suffix:
Gender:M
Credentials:RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 PROVIDENCE POINT DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5167
Mailing Address - Country:US
Mailing Address - Phone:678-799-5661
Mailing Address - Fax:
Practice Address - Street 1:2218 PROVIDENCE POINT DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5167
Practice Address - Country:US
Practice Address - Phone:678-799-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000396363AS0400X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical