Provider Demographics
NPI:1366603433
Name:MANNS, JACK E (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:E
Last Name:MANNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2898
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30015-7898
Mailing Address - Country:US
Mailing Address - Phone:770-786-1234
Mailing Address - Fax:678-712-6977
Practice Address - Street 1:4159 MILL ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2546
Practice Address - Country:US
Practice Address - Phone:770-786-1234
Practice Address - Fax:678-712-6977
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA68062207W00000X
VA0101249309207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology