1215198221 NPI number — MCDONALD AND MANUS LLP

Table of content: (NPI 1215198221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215198221 NPI number — MCDONALD AND MANUS LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCDONALD AND MANUS LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215198221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 PRINCE AVE
Provider Second Line Business Mailing Address:
SUITE 103 SOUTH
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30606-5805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-548-0604
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 PRINCE AVE
Provider Second Line Business Practice Location Address:
SUITE 103 SOUTH
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-5805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-548-0604
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCDONALD JR.
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ORAL SURGEON
Authorized Official Telephone Number:
706-548-0604

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)