MEDICARE: MICHAEL JOSEPH MANNING 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	033397	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	4119030001	OTHER	GA	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0106242	OTHER	GA	UNITED HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	582361278	OTHER	GA	FEDERAL TAX ID
4	005301	OTHER	GA	CIGNA HEALTHCARE
6	5124	OTHER	GA	KAISER PERMANENTE
7	080119233	OTHER	GA	RAILROAD RETIREMENT MEDIC

General Provider Information

NPI Number	:	1891791596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOSEPH MANNING M.D.

Provider Business Mailing Address
First Line	:	2215 EXCHANGE PL SE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6723
Country	:	US
Telephone Number	:	770-922-3522
Fax Number	:	770-922-3662

Provider Business Practice Location Address
First Line	:	2215 EXCHANGE PL SE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6723
Country	:	US
Telephone Number	:	770-922-3522
Fax Number	:	770-922-3662

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	11/29/2017

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