Mantrust, LLC

NPI #1316331101 in Dothan, Alabama

Provider Information

NPI Number: 1316331101
Entity Type: Organization
Organization Name: Mantrust, LLC
Primary Specialty: General Practice
Enumeration Date: Mar 19, 2015
Last Updated: Mar 19, 2015

Practice Location

Address: 2812 HARTFORD HWY
Address 2: SUITE 1
City: Dothan
State: Alabama
ZIP Code: 36305-4927
Phone: (334) 712-1170

Authorized Official

Name: NANCY GILLEY
Title: ADMINISTRATOR
Phone: (334) 712-1170

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X
Psychiatry & Neurology - Neurology — Neurology	2084N0400X
Psychiatry & Neurology - Psychiatry — Psychiatry	2084P0800X
General Practice	208D00000X	Primary

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