MEDICARE: ABDUL MANAF

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1790612778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDUL MANAF

Provider Business Mailing Address
First Line	:	1200 MEMORIAL DRIVE
Second Line	:
City	:	DALTON CITY
State	:	GA
Zip	:	30720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	INTERNAL MEDICINE CLINIC
Second Line	:	1432 BROADRICK DR
City	:	DALTON
State	:	GA
Zip	:	30720
Country	:	US
Telephone Number	:	706-226-8990
Fax Number	:	706-529-5317

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

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “ ABDUL MANAF ” Practice Location

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