Provider Demographics
NPI:1780881862
Name:MANIATIS, COURTNEY (DO)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MANIATIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:STANNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1192 BUCKHEAD XING
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-4254
Mailing Address - Country:US
Mailing Address - Phone:678-238-0301
Mailing Address - Fax:678-238-0323
Practice Address - Street 1:1192 BUCKHEAD XING
Practice Address - Street 2:SUITE C
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-4254
Practice Address - Country:US
Practice Address - Phone:678-238-0301
Practice Address - Fax:678-238-0323
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63919208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice