Provider Demographics
NPI:1811474828
Name:MCMANIS, HEATHER WHITNEY (FNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:WHITNEY
Last Name:MCMANIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WHITE POND RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-6631
Mailing Address - Country:US
Mailing Address - Phone:417-499-9784
Mailing Address - Fax:
Practice Address - Street 1:200 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-3843
Practice Address - Country:US
Practice Address - Phone:229-333-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily