Basic Information
| Provider Information | |||||||||
| NPI: | 1144544834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANLEY | ||||||||
| FirstName: | EMILY | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 771 OLD NORCROSS ROAD | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | LAURENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300464981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709625040 | ||||||||
| FaxNumber: | 7709625056 | ||||||||
| Practice Location | |||||||||
| Address1: | 771 OLD NORCROSS ROAD | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | LAURENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300464981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709625040 | ||||||||
| FaxNumber: | 7709625056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2010 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 005279 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.