Healthcare Provider Details

I. General information

NPI: 1497752760
Provider Name (Legal Business Name): FANI B MANNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 11/08/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S DUNCAN ST
JAMESTOWN TN
38556-3009
US

IV. Provider business mailing address

PO BOX 2861
CROSSVILLE TN
38557-2861
US

V. Phone/Fax

Practice location:
  • Phone: 931-879-5864
  • Fax:
Mailing address:
  • Phone: 931-200-2246
  • Fax: 931-707-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number61336
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number37851
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number20422
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: