Healthcare Provider Details

I. General information

NPI: 1114866167
Provider Name (Legal Business Name): MANUEL EDUARDO TORRES ONTIVEROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 GORDON AVE
THOMASVILLE GA
31792-6614
US

IV. Provider business mailing address

51 COHEN WALKER DR APT 2606
WARNER ROBINS GA
31088-0767
US

V. Phone/Fax

Practice location:
  • Phone: 229-228-2000
  • Fax:
Mailing address:
  • Phone: 720-296-2149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: