Healthcare Provider Details

I. General information

NPI: 1982910337
Provider Name (Legal Business Name): JOSEPH A. MANNO III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSEPH MANNO MD

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 03/21/2023
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 SIMPSON ST
GREENVILLE SC
29605-4413
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-522-3900
  • Fax: 864-522-3909
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number33254
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: