Healthcare Provider Details

I. General information

NPI: 1720929052
Provider Name (Legal Business Name): MORGAN NICOLE MCMANUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 W FARIS RD
GREENVILLE SC
29605-4289
US

IV. Provider business mailing address

877 W FARIS RD SUITE A
GREENVILLE SC
29605-4289
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7800
  • Fax:
Mailing address:
  • Phone: 864-455-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL96904
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: