Provider Demographics
NPI:1427051804
Name:MANLEY, JOHN ALAN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:MANLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4104
Mailing Address - Country:US
Mailing Address - Phone:828-258-8545
Mailing Address - Fax:828-254-0714
Practice Address - Street 1:10 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4104
Practice Address - Country:US
Practice Address - Phone:828-258-8545
Practice Address - Fax:828-254-0714
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000534207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127F3OtherNC BLUE CROSS PROVIDER #
SCQ0053BMedicaid
NC89127F3Medicaid
NC2280677Medicare PIN
NC390007230Medicare PIN
NC89127F3Medicaid
NC390007230Medicare PIN