Provider Demographics
NPI:1861205965
Name:MCMANUS, JENNIFER C (COA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:C
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1255 FRIENDSHIP RD STE 160
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-5618
Mailing Address - Country:US
Mailing Address - Phone:678-528-1101
Mailing Address - Fax:
Practice Address - Street 1:1255 FRIENDSHIP RD STE 160
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5618
Practice Address - Country:US
Practice Address - Phone:678-528-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA162222156FX1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant