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NPI Code Detail

MEDICARE: DR. ROBERT MANIS MD

MEDICARE:  DR. ROBERT  MANIS  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171W00000XContractor13853GA
2174400000XSpecialist13853GA

General Provider Information

NPI Number : 1891031472
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT MANIS MD
Provider Business Mailing Address
First Line : 4167 ROSWELL RD
Second Line :
City : ATLANTA
State : GA
Zip : 30342-3715
Country : US
Telephone Number : 404-252-5055
Fax Number : 404-252-5589
Provider Business Practice Location Address
First Line : 4167 ROSWELL RD
Second Line :
City : ATLANTA
State : GA
Zip : 30342-3715
Country : US
Telephone Number : 404-252-5055
Fax Number : 404-252-5589
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2012
Last Update Date : 12/30/2012

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Directions to “ DR. ROBERT MANIS MD” Practice Location

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