Individual
JOHN BENNETT MANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
5336 SUNSET BLVD STE A, LEXINGTON, SC 29072-9393
(803) 567-8900
(803) 567-8909
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
24005
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP6995
—
SC
Enumeration date
06/22/2020
Last updated
11/14/2022
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