Individual
ANTHONY D MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEADOWS PKWY, VIDALIA, GA 30474-8759
(912) 538-5359
(912) 538-5228
Mailing address
PO BOX 1303, VIDALIA, GA 30475-1303
(912) 538-5359
(912) 538-5228
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
074890
GA
207L00000X
Anesthesiology Physician
39238
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64098015
—
KY
Enumeration date
08/22/2005
Last updated
10/26/2018
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