Provider Demographics
NPI:1952363202
Name:MANNINO, SALVATORE F (DO)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:F
Last Name:MANNINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:770-528-9938
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-424-6893
Practice Address - Fax:770-528-9938
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2019-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA56133207RC0000X, 207RH0005X, 207UN0901X, 207UN0902X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA921265069RMedicaid
GA921265069SMedicaid
GA921265069UMedicaid
GA921265069QMedicaid
GA921265069TMedicaid
GA921265069UMedicaid
GAI33229Medicare UPIN