Individual
IVIENSAN FERNANDEZ MANALO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
875 JOHNSON FY RD NE STE 300, ATLANTA, GA 30342-1418
(404) 257-9933
Mailing address
875 JOHNSON FY RD NE STE 300, ATLANTA, GA 30342-1418
(404) 257-9933
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
85708
GA
Other
Enumeration date
04/04/2016
Last updated
07/20/2020
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