Provider Demographics
NPI:1194709329
Name:MANN, BOB B (MD)
Entity type:Individual
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First Name:BOB
Middle Name:B
Last Name:MANN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:775 POPLAR RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-8300
Mailing Address - Country:US
Mailing Address - Phone:770-470-0463
Mailing Address - Fax:678-423-2737
Practice Address - Street 1:775 POPLAR RD
Practice Address - Street 2:SUITE 160
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8300
Practice Address - Country:US
Practice Address - Phone:770-470-0463
Practice Address - Fax:678-423-2737
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-11-01
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Provider Licenses
StateLicense IDTaxonomies
GA023185208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA023185OtherGEORGIA MEDICAL LICENSE
GAD40537Medicare UPIN