Healthcare Provider Details

I. General information

NPI: 1831126812
Provider Name (Legal Business Name): RICKEY D MANNING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 E EMORY RD
KNOXVILLE TN
37938-4229
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 865-922-2121
  • Fax: 833-908-2092
Mailing address:
  • Phone: 865-584-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20885
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: