Provider Demographics
NPI:1336829654
Name:MANNER, QWUAYANA (CPHT)
Entity Type:Individual
Prefix:
First Name:QWUAYANA
Middle Name:
Last Name:MANNER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 BRIARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-5505
Mailing Address - Country:US
Mailing Address - Phone:478-279-8578
Mailing Address - Fax:
Practice Address - Street 1:609 BRIARCLIFF RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5505
Practice Address - Country:US
Practice Address - Phone:478-279-8578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30048089183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician