Provider Demographics
NPI:1598587206
Name:LOWERY, MANNIE JR (DC)
Entity type:Individual
Prefix:
First Name:MANNIE
Middle Name:
Last Name:LOWERY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 GODBY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5060
Mailing Address - Country:US
Mailing Address - Phone:770-990-4560
Mailing Address - Fax:
Practice Address - Street 1:2245 GODBY RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5059
Practice Address - Country:US
Practice Address - Phone:770-990-4560
Practice Address - Fax:770-216-1626
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR011149111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner