Healthcare Provider Details

I. General information

NPI: 1023634094
Provider Name (Legal Business Name): BRIANNA MCMANUS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 OLD QUACCO RD APT 2106
POOLER GA
31322-0559
US

IV. Provider business mailing address

2200 OLD QUACCO RD APT 2106
POOLER GA
31322-0559
US

V. Phone/Fax

Practice location:
  • Phone: 270-903-1736
  • Fax:
Mailing address:
  • Phone: 270-903-1736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT004706
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT007108
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATR2159
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: