NPIMap

Organization Active NPI

Manna Scholarship Fund Inc

  • Adult Mental Health Clinic/Center
  • Duluth, GA
National Provider Identifier
1083089239
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
MANNA SCHOLARSHIP FUND INC
Practice address
3305 Breckinridge Blvd Ste 116
Duluth, GA 30096-4932
Phone
(770) 495-9775
Fax
(770) 495-9745
NPI assigned
Dec 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

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

Authorized official

Name
Elizabeth Gene Burnett, PSYDNPI 1548469695
Title
Director
Phone
(770) 495-9775

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Adult Mental Health Clinic/Center 261QM0850X Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

3305 Breckinridge Blvd Ste 116
Duluth, GA 30096-4932

Mailing address

3305 Breckinridge Blvd Ste 116
Duluth, GA 30096-4932
Phone (770) 495-9775

Other names 1

  • Manna Treatment Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201001003087 GA Part B Supplier - Clinic/Group Practice 6709215817 Receives reassigned benefits from 6 practitioners
Practice locations: Duluth, GA

National Provider Directory

National Provider Directory
Tax ID family
Manna Scholarship Fund2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3305 Breckinridge Blvd
Ste 122
Duluth, GA 30096
Phone (770) 495-9775

965 Oakland Rd
Ste 3DE
Lawrenceville, GA 30044

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1449964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1083089239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3305 BRECKINRIDGE BLVD STE 116",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964932",
            "telephone_number": "770-495-9775",
            "fax_number": "770-495-9745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 BRECKINRIDGE BLVD STE 116",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964932",
            "telephone_number": "770-495-9775",
            "fax_number": "770-495-9745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANNA SCHOLARSHIP FUND INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-13",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "BURNETT",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "770-495-9775",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manna Treatment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.