Provider Demographics
NPI:1356674840
Name:POLLARD-MANIGAULT, M DENISE (NP)
Entity type:Individual
Prefix:DR
First Name:M DENISE
Middle Name:
Last Name:POLLARD-MANIGAULT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:M DENISE
Other - Middle Name:
Other - Last Name:POLLARD-MANIAGULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2015 UPPER GATE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1014
Mailing Address - Country:US
Mailing Address - Phone:404-785-3864
Mailing Address - Fax:
Practice Address - Street 1:2015 UPPER GATE DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1014
Practice Address - Country:US
Practice Address - Phone:404-785-3864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381487363LP0200X
GARN234981363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics