Carolina Marie Manceaux, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

14267404-1206 Issued in UT

Practice address

2409 N Patterson St
Valdosta, GA 31602-2512

Phone

(229) 259-4369

NPI assigned

Nov 7, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Carolina Reis Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• SGMC Physician Network Inc

  • Multi-Specialty Clinic/Center
  • Valdosta, GA
  • NPI 1417597170
  Medicare reassignment
• SGMC Affiliated Services LLC

  • Multi-Specialty Clinic/Center
  • Valdosta, GA
  • NPI 1114740362
  NPD

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

{
    "created_epoch": "1667779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778716800000",
    "number": "1124736319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2409 N PATTERSON ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022512",
            "telephone_number": "229-259-4369"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9450 S 1300 E",
            "address_purpose": "LOCATION",
            "city": "Sandy",
            "state": "UT",
            "postal_code": "840945555",
            "country_code": "US",
            "telephone_number": "801-501-2160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANCEAUX",
        "first_name": "CAROLINA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-07",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "11461",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "14267404-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC/ Office Ally",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CAROLINA",
            "last_name": "REIS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Magnolia Transit
• Michelle Mahas, PP
• Brendan Michael Mahoney
• Joel Don Malin
• Ashley Renee Malone
• Twyla Lucinda Mancil, PH. D.
• Amrendra Kumar Mandal
• Tashari Shameka Manning
• Mafaz Mansoor, MD
• Alexis Marable

• Physician Assistant in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.