Healthcare Provider Details

I. General information

NPI: 1659451805
Provider Name (Legal Business Name): VICTORIA D MANNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 POLLARDS POND RD
APPLING GA
30802-3726
US

IV. Provider business mailing address

6420 POLLARDS POND RD
APPLING GA
30802-3726
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-3330
  • Fax: 706-868-3336
Mailing address:
  • Phone: 706-868-3330
  • Fax: 706-868-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberRN052799
License Number StateGA

VIII. Authorized Official

Name: MRS. PHYLLIS ROLAND
Title or Position: FACILITY ADMIN
Credential: RN
Phone: 706-868-3330