Provider Demographics
NPI:1558181834
Name:MANDERS, ARLENE CAROLE (NP)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:CAROLE
Last Name:MANDERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7196 BRONWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:BRONWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:39826-4200
Mailing Address - Country:US
Mailing Address - Phone:229-886-2385
Mailing Address - Fax:
Practice Address - Street 1:7196 BRONWOOD HWY
Practice Address - Street 2:
Practice Address - City:BRONWOOD
Practice Address - State:GA
Practice Address - Zip Code:39826-4200
Practice Address - Country:US
Practice Address - Phone:229-886-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222378363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health