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General NPI Number Information
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NPI Number | 1376978007
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Entity Type | Organization
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Legal Business Name | G. WILLIAM MANIFOLD, M.D., P.C.
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 1208 SOMERVILLE RD SE
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City | DECATUR
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State | AL
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Zip | 35601-4335
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Country | US
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Telephone | 256-318-4380
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1684
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City | DECATUR
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State | AL
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Zip | 35602-1684
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Country | US
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Telephone | 256-350-4855
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE WILLIAM MANIFOLD
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Credential | M.D.
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Telephone | 256-318-4380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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