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General NPI Number Information
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NPI Number | 1669428744
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Entity Type | Individual
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Provider Name | ALISSA MARIE MANFREDI MD
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Gender | Female
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 701 GROVE RD
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City | GREENVILLE
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State | SC
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Zip | 29605-5611
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Country | US
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Telephone | 864-455-3140
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Fax | 864-455-4525
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Provider Business Mailing Address
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Address Line | 1 INDEPENDENCE PT SUITE 212
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City | GREENVILLE
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State | SC
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Zip | 29615-4545
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Country | US
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Telephone | 864-797-6044
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Fax | 864-797-6198
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 30113
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 30113
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207PH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Emergency Medicine) Physician
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License Number | 30113
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License Number State | SC
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