Individual
RICHARD LEON MANRIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1816 EAGLE DR, SUITE 200-B, WOODSTOCK, GA 30189-8272
(404) 822-5605
Mailing address
PO BOX 28118, ATLANTA, GA 30358-0118
(404) 822-5605
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
031286
GA
208D00000X
General Practice Physician
Primary
031286
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000395216L
—
GA
Enumeration date
07/02/2006
Last updated
09/21/2009
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