1982686846 NPI number — AURELIO D MANTO MD

Table of content: AURELIO D MANTO MD (NPI 1982686846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982686846 NPI number — AURELIO D MANTO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANTO
Provider First Name:
AURELIO
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1982686846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 COWLES CLINC WAY
Provider Second Line Business Mailing Address:
STE A-200
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30642-5287
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-923-2146
Provider Business Mailing Address Fax Number:
706-923-2141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 COWLES CLINC WAY STE C-300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30642-5288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
67-999-9710
Provider Business Practice Location Address Fax Number:
706-999-0274
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RA0000X , with the licence number:  152291 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 63265 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 414741507B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 414741507F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 414741507A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J18071 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3167208 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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