Ebot B Manga

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

147685 Issued in GA

Practice address

2064 Lilac Arbor Way
Dacula, GA 30019-2475

Phone

(678) 887-4367

NPI assigned

Jan 29, 2018

Last updated

Jul 20, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Ebot B. Manga Professional name

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Expert Wound Care LLC

  • Family Medicine Physician
  • Gainesville, GA
  • NPI 1063234367
  Medicare reassignment NPD
• Amazing Family & Healthcare Services LLC

  • Nurse Practitioner
  • Loganville, GA
  • NPI 1518666346
  NPD Authorized official
• Altix Medical Ga P.C.

  • General Practice Physician
  • Alpharetta, GA
  • NPI 1730012089
  NPD (past)

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

{
    "created_epoch": "1517184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1164920716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2064 LILAC ARBOR WAY",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300192475",
            "telephone_number": "678-887-4367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2064 LILAC ARBOR WAY",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300192475",
            "telephone_number": "678-887-4367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGA",
        "first_name": "EBOT",
        "middle_name": "B",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-29",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "147685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EBOT",
            "last_name": "MANGA",
            "middle_name": "B.",
            "prefix": "MR.",
            "credential": "FNP C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Amy Mahaley, NP
• Mirela Makarevic
• Charles Greg Malone
• Michelle Malvo
• Manga Health Consultants, Dba / Regional (Regional Home Care Services)
• Mangiarelli Rehabilitation of Georgia LLC
• Makayla Forrest Mangram, ATC
• Alicia Manley, MED, CCC-SLP
• Cory Kane Mansour, M.D.
• Stephanie L Marie, RBT

• Family Nurse Practitioner in Dacula, GA
• Providers in Dacula, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; 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.