Individual
CAROLINA MARIE MANCEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2409 N PATTERSON ST, VALDOSTA, GA 31602-2512
(229) 259-4369
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11461
GA
363A00000X
Physician Assistant
Primary
14267404-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/07/2022
Last updated
05/14/2026
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