Individual
HENRY A MANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
2400 BELLEVUE RD, 16 ERIN OFC PARK, DUBLIN, GA 31021-2885
(478) 275-7546
Mailing address
2400 BELLEVUE RD, SUITE 21-A, DUBLIN, GA 31021-2885
(478) 275-7202
(478) 274-8418
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003255
GA
363AM0700X
Medical Physician Assistant
003255
GA
363AS0400X
Surgical Physician Assistant
003255
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
553969817C
—
GA
01
—
DC4061
RAILROAD MEDICARE
GA
Enumeration date
09/02/2005
Last updated
03/12/2015
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