Healthcare Provider Details

I. General information

NPI: 1982686846
Provider Name (Legal Business Name): AURELIO D MANTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 PRINCE AVE
ATHENS GA
30606-6032
US

IV. Provider business mailing address

2005 PRINCE AVE
ATHENS GA
30606-6032
US

V. Phone/Fax

Practice location:
  • Phone: 617-943-3934
  • Fax: 706-208-0878
Mailing address:
  • Phone: 617-943-3934
  • Fax: 706-208-0878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number152291
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number63265
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: