MEDICARE: ANDREA MANNING RN

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	101YM0800X	Mental Health Counselor	RN059063	GA

General Provider Information

NPI Number	:	1548702939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA MANNING RN

Provider Business Mailing Address
First Line	:	PO BOX 6741
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-0741
Country	:	US
Telephone Number	:	404-755-3003
Fax Number	:	404-755-3008

Provider Business Practice Location Address
First Line	:	1136 METROPOLITAN PKWY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-3544
Country	:	US
Telephone Number	:	404-755-3003
Fax Number	:	404-755-3008

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

Provider Enumeration Date	:	11/16/2016
Last Update Date	:	11/16/2016

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