Individual
KELLY J. MANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1831 5TH AVE, COLUMBUS, GA 31904-8915
(706) 320-8780
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
01058411A
IN
207VX0201X
Gynecologic Oncology Physician
Primary
72318
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200135230A
—
IN
Enumeration date
09/29/2005
Last updated
08/31/2020
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