Provider Demographics
NPI:1912960162
Name:MANUELE, JAMES CARL JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CARL
Last Name:MANUELE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0187
Mailing Address - Country:US
Mailing Address - Phone:662-417-5475
Mailing Address - Fax:
Practice Address - Street 1:237 E TAYLOR ST
Practice Address - Street 2:STE A
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3723
Practice Address - Country:US
Practice Address - Phone:662-417-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23335207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0166707OtherUMWA
OK200008940AMedicaid
TN3866766Medicaid
OKG98769OtherSTERLING OPTION 1
OK1324230001OtherPALMETTO DME
TN4319968OtherBCBS TN
OK731310891028OtherTRICARE SOUTH
OK200008940BOtherSOONER PCP
7210214OtherAETNA
OK74502A048OtherCHAMPUS (WPS)
OK731310891006OtherUNICARE
OKP00015678OtherRR MEDICARE (PALMETTO)
OK200008940AMedicaid
OK1324230001OtherPALMETTO DME
OK74502A048OtherCHAMPUS (WPS)