Organization
MANTRUST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY GILLEY (ADMINISTRATOR)
(334) 712-1170
Entity
Organization
Contact information
Practice address
2812 HARTFORD HWY, SUITE 1, DOTHAN, AL 36305-4927
(334) 712-1170
Mailing address
2812 HARTFORD HWY, SUITE 1, DOTHAN, AL 36305-4927
(334) 712-1170
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
03/19/2015
Last updated
03/19/2015
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