MEDICARE: MANUEL COUTINHO

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	208000000X	Pediatrics Physician	315941	NY
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208000000X	Pediatrics Physician	102857	GA

General Provider Information

NPI Number	:	1477012243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUEL COUTINHO

Provider Business Mailing Address
First Line	:	121 MARBLE MILL RD NW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-7959
Country	:	US
Telephone Number	:	770-422-8315
Fax Number	:	770-590-9170

Provider Business Practice Location Address
First Line	:	121 MARBLE MILL RD NW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-7959
Country	:	US
Telephone Number	:	770-422-8315
Fax Number	:	770-590-9170

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	04/28/2026

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Directions to “ MANUEL COUTINHO ” Practice Location

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