Mantrust, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MANTRUST, LLC

Practice address

2812 Hartford Hwy
Suite 1
Dothan, AL 36305-4927

Phone

(334) 712-1170

NPI assigned

Mar 19, 2015

Last updated

Mar 19, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nancy Gilley

Title

Administrator

Phone

(334) 712-1170

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1426723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426723200000",
    "number": "1316331101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2812 HARTFORD HWY",
            "address_2": "SUITE 1",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363054927",
            "telephone_number": "334-712-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2812 HARTFORD HWY",
            "address_2": "SUITE 1",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363054927",
            "telephone_number": "334-712-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANTRUST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-19",
        "last_updated": "2015-03-19",
        "status": "A",
        "authorized_official_last_name": "GILLEY",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "334-712-1170"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Ryan Mangnitz, M.D.
• Anna Maria Mangra
• Dhanabhakya Lakshmi Manimegalai Jeyasekaran, MD
• John V Manning Jr., P.A. - C
• Srikanth Mansani, M.D
• Kinza Amar Maqsood, MD
• Marathon Health LLC
• Kelli Marchman, CRNA
• Martin E Margolies, MD
• Sophia Shea Marino, PA-C

• General Practice Physician in Dothan, AL
• Providers in Dothan, AL by specialty
• General Practice Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.