Active NPI
Joanna Mannon, ATC, SCAT
- Other Technician
- Myrtle Beach, SC
National Provider Identifier
1619336930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 1817
- Practice address
- 3302 Robert M Grissom Pkwy
Myrtle Beach, SC 29577-6401 - Phone
- (843) 488-7149
- NPI assigned
- Feb 15, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 1817 | SC | Primary |
Addresses
Primary practice location
3302 Robert M Grissom Pkwy
Myrtle Beach, SC 29577-6401
Mailing address
501 Hay Hill LN Unit a
Myrtle Beach, SC 29579-4292
Phone (704) 778-5612
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1817 | SC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455494400000",
"number": "1619336930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 HAY HILL LN UNIT A",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295794292",
"telephone_number": "704-778-5612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3302 ROBERT M GRISSOM PKWY",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295776401",
"telephone_number": "843-488-7149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANNON",
"first_name": "JOANNA",
"credential": "ATC, SCAT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-15",
"last_updated": "2016-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "SC",
"license": "1817",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.