Provider Demographics
NPI:1063507572
Name:CORNELIUS J. MANCE, M.D., P.C.
Entity type:Organization
Organization Name:CORNELIUS J. MANCE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:JEFFERSON
Authorized Official - Last Name:MANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-954-9556
Mailing Address - Street 1:5309 INLET VIEW LANE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343
Mailing Address - Country:US
Mailing Address - Phone:423-954-9556
Mailing Address - Fax:423-954-9505
Practice Address - Street 1:2051 B HAMILL ROAD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:423-877-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3046304Medicaid
TN3074846OtherBLUECROSS/BLUESHIELD
3046300Medicare ID - Type Unspecified
TN3046304Medicaid