Provider Demographics
NPI:1053429548
Name:MANZONE, CHRISTOPHER P (PA C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
Last Name:MANZONE
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 7TH AVE
Mailing Address - Street 2:MODULE E
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3166
Mailing Address - Country:US
Mailing Address - Phone:770-595-1289
Mailing Address - Fax:
Practice Address - Street 1:INTERNAL MEDICINE HEALTH CARE TEAM A
Practice Address - Street 2:20 GLENLAKE PARKWAY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-365-0966
Practice Address - Fax:770-677-7333
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60044453363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
97WCGBSMedicare ID - Type Unspecified
Q28538Medicare UPIN