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1164920716
EBOT B MANGA
DACULA, GA
NPI
1164920716
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Professional Name
EBOT B. MANGA
Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: GA 147685)
Enumeration Date
2018-01-29
Last Update Date
2021-07-20
Business Address
EBOT B MANGA
2064 LILAC ARBOR WAY
DACULA, GA 30019-2475
Phone number: 678-887-4367
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Mailing Address
EBOT B MANGA
2064 LILAC ARBOR WAY
DACULA, GA 30019-2475
Phone number: 678-887-4367
Copy
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