Provider Demographics
NPI:1215278882
Name:MANNA MEDICAL & COUNSELING
Entity type:Organization
Organization Name:MANNA MEDICAL & COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-372-9280
Mailing Address - Street 1:305 CARROLLTON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:GA
Mailing Address - Zip Code:30178
Mailing Address - Country:US
Mailing Address - Phone:770-562-0777
Mailing Address - Fax:770-562-0333
Practice Address - Street 1:305 CARROLLTON HIGHWAY
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:GA
Practice Address - Zip Code:30178
Practice Address - Country:US
Practice Address - Phone:770-562-0777
Practice Address - Fax:770-562-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA32101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty