Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 041614 | GA |
N | 207VG0400X | Gynecologist | 041614 | GA |
NPI | 1730179805 |
---|---|
Provider Name | Peter Chun-Chung Mann |
First Address | Snellville, GA 30078-2016 |
Second Address | Snellville, GA 30078-2016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 04/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E79032 | (02) | GA |