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General NPI Number Information
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NPI Number | 1326629502
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Entity Type | Individual
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Provider Name | JOSHUA LEE MANUEL MD
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Gender | Male
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 04/16/2026
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Provider Practice Location Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone | 817-702-1244
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 15TH ST # OR2029
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City | AUGUSTA
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State | GA
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Zip | 30912-0004
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Country | US
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Telephone | 706-721-8623
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 103754
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | U1958
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License Number State | TX
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