Healthcare Provider Details

I. General information

NPI: 1023210895
Provider Name (Legal Business Name): MANUEL PIRI NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 MULKEY RD SUITE A
AUSTELL GA
30106-1170
US

IV. Provider business mailing address

1676 MULKEY RD SUITE A
AUSTELL GA
30106-1170
US

V. Phone/Fax

Practice location:
  • Phone: 678-838-6600
  • Fax: 678-838-6602
Mailing address:
  • Phone: 678-838-6600
  • Fax: 678-838-6602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN154748
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: