Provider Demographics
NPI:1144544834
Name:MANLEY, EMILY (PA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MANLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 OLD NORCROSS ROAD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LAURENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4981
Mailing Address - Country:US
Mailing Address - Phone:770-962-5040
Mailing Address - Fax:770-962-5056
Practice Address - Street 1:771 OLD NORCROSS ROAD
Practice Address - Street 2:SUITE 260
Practice Address - City:LAURENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4981
Practice Address - Country:US
Practice Address - Phone:770-962-5040
Practice Address - Fax:770-962-5056
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005279363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant