Provider Demographics
NPI:1730179805
Name:MANN, PETER CHUN-CHUNG (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:CHUN-CHUNG
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1800 TREE LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2016
Mailing Address - Country:US
Mailing Address - Phone:770-972-6464
Mailing Address - Fax:770-978-4819
Practice Address - Street 1:1800 TREE LN
Practice Address - Street 2:SUITE 300
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2016
Practice Address - Country:US
Practice Address - Phone:770-972-6464
Practice Address - Fax:770-978-4819
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA041614207VG0400X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE79032Medicare UPIN
GAE79032Medicare UPIN