Individual provider Active NPI

Christopher P Manzone, PA C

  • Medical Physician Assistant
  • Atlanta, GA
National Provider Identifier
1053429548
Registry record updated Feb 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA60044453 Issued in WA
Practice address
Internal Medicine Health Care Team a
20 Glenlake Parkway
Atlanta, GA 30328
Phone
(404) 365-0966
Fax
(770) 677-7333
NPI assigned
Aug 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA60044453 WA Primary

Addresses

Primary practice location

Internal Medicine Health Care Team a
20 Glenlake Parkway
Atlanta, GA 30328

Mailing address

1230 7TH Ave
Module E
Longview, WA 98632-3166
Phone (770) 595-1289

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090624000018 WA Practitioner - Physician Assistant 6800850132 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA60044453WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince May 27, 2019 Accepting new patients

Locations

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233532800000",
    "number": "1053429548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 7TH AVE",
            "address_2": "MODULE E",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323166",
            "telephone_number": "770-595-1289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "INTERNAL MEDICINE HEALTH CARE TEAM A",
            "address_2": "20 GLENLAKE PARKWAY",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30328",
            "telephone_number": "404-365-0966",
            "fax_number": "770-677-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANZONE",
        "first_name": "CHRISTOPHER",
        "middle_name": "P",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-26",
        "last_updated": "2009-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60044453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.