Individual
MR. JUAN MANNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.S.A.
Contact information
Practice address
2218 PROVIDENCE POINT DR, LITHONIA, GA 30058-5167
(678) 799-5661
Mailing address
2218 PROVIDENCE POINT DR, LITHONIA, GA 30058-5167
(678) 799-5661
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
238.000396
IL
363AS0400X
Surgical Physician Assistant
238.000396
IL
Other
Enumeration date
03/09/2009
Last updated
06/03/2015
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