Individual
MELANTHA DORTHEA MANNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4500 13TH STREET, GULFPORT, MS 39501
(228) 867-4396
(228) 867-5354
Mailing address
PO BOX 1810, GULFPORT, MS 39502
(228) 575-1194
(228) 575-2917
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20915
MS
208M00000X
Hospitalist Physician
20915
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03442094
—
MS
Enumeration date
09/21/2009
Last updated
10/04/2023
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