Provider Demographics
NPI:1376230953
Name:MANNING, KEYONNA (CPHT)
Entity type:Individual
Prefix:MS
First Name:KEYONNA
Middle Name:
Last Name:MANNING
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 1:5401 FAIRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-5113
Mailing Address - Country:US
Mailing Address - Phone:404-719-6140
Mailing Address - Fax:
Practice Address - Street 1:5401 FAIRINGTON RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-5113
Practice Address - Country:US
Practice Address - Phone:404-719-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30076349183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician