MEDICARE: DR. HEATHER MICHELLE MANOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2009-01740	NC
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	2009-01740	NC

General Provider Information

NPI Number	:	1427186022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER MICHELLE MANOS M.D.

Provider Business Mailing Address
First Line	:	1200 MYRTLE AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4540
Country	:	US
Telephone Number	:	704-995-1992
Fax Number	:

Provider Business Practice Location Address
First Line	:	6010 E WT HARRIS BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-4084
Country	:	US
Telephone Number	:	704-208-4134
Fax Number	:	704-248-8068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	03/07/2023

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