Individual
HEATHER MARIE GOODWIN MANCEBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2130 W SPRING STREET, SUITE 300, MONROE, GA 30655
(678) 905-9121
Mailing address
296 HAMBY LN, SOCIAL CIRCLE, GA 30025-4851
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
282980
NY
207Q00000X
Family Medicine Physician
Primary
96784
GA
207Q00000X
Family Medicine Physician
D0074885
MD
Other
Enumeration date
06/24/2009
Last updated
08/18/2023
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