Provider Demographics
NPI:1740370691
Name:MANN, THOMAS R (MDPC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:MANN
Suffix:
Gender:M
Credentials:MDPC
Other - Prefix:
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Mailing Address - Street 1:118 NORMAN DORMINY DR
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8858
Mailing Address - Country:US
Mailing Address - Phone:229-423-9561
Mailing Address - Fax:229-424-7097
Practice Address - Street 1:118 NORMAN DORMINY DRIVE
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750
Practice Address - Country:US
Practice Address - Phone:229-424-0134
Practice Address - Fax:229-424-9383
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-02-02
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Provider Licenses
StateLicense IDTaxonomies
GAGA37607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000617251AMedicaid
GA11BDVQVMedicare PIN
GA000617251AMedicaid