Active NPI
Kiley Elizabeth Manetta, D.O.
- Obstetrics & Gynecology Physician
- Alpharetta, GA
National Provider Identifier
1689871295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 82190
- Practice address
- 11975 Morris Road Suite 300
Alpharetta, GA 30005-3427 - Phone
- (770) 521-2295
- Fax
- (770) 255-0333
- NPI assigned
- Jun 27, 2007
- Last updated
- Oct 14, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 82190 | GA | Primary |
Addresses
Primary practice location
11975 Morris Road Suite 300
Alpharetta, GA 30005-3427
Mailing address
5780 Peachtree Dunwoody Road Suite 300
Atlanta, GA 30342
Phone (404) 303-8035
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 20, 2019 through Jun 20, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 82190 | GA | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northside Hospital, Inc. | Past | Accepting new patients | |
| Northside Womens Group LLC | Obstetrics & Gynecology | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Northside Hospital Cherokee
- General Acute Care Hospital
- Canton, GA
- NPI 1225050396
-
dba Northside WGG
- Obstetrics & Gynecology Physician
- Lawrenceville, GA
- NPI 1275380701
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571011200000",
"number": "1689871295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5780 PEACHTREE DUNWOODY ROAD SUITE 300",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30342",
"telephone_number": "404-303-8035",
"fax_number": "404-303-1325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11975 MORRIS ROAD SUITE 300",
"city": "ALPHARETTA",
"state": "GA",
"postal_code": "300053427",
"telephone_number": "770-521-2295",
"fax_number": "770-255-0333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANETTA",
"first_name": "KILEY",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-27",
"last_updated": "2019-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "GA",
"license": "82190",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alpharetta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2019; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.