Healthcare Provider Details

I. General information

NPI: 1659231298
Provider Name (Legal Business Name): ZACHARY MICHAEL MCMANUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ZACK MCMANUS

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 RIVER OAKS DR
FLOWOOD MS
39232-9729
US

IV. Provider business mailing address

708 WINDING HILLS DR
CLINTON MS
39056-6331
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-1030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberSTUDENT
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: