MEDICARE: DR. JOHN E. MANN JR. 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	05295	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080121055	OTHER		RAILROAD MEDICARE
3	288056YJ8J	OTHER	MS	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922080316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN E. MANN JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2106
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39302-2106
Country	:	US
Telephone Number	:	601-703-4282
Fax Number	:	601-703-3080

Provider Business Practice Location Address
First Line	:	1106 CENTRAL DR
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-8972
Country	:	US
Telephone Number	:	601-656-6921
Fax Number	:	601-656-0381

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

Provider Enumeration Date	:	11/19/2005
Last Update Date	:	03/17/2018

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