Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ebot B Manga

Individual provider Family Nurse Practitioner · NPI 1164920716

Ebot B Manga is a Nurse Practitioner in Dacula, Georgia. Qualified in 2016, 10 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
10
Licensed in
GA
In the registry since
2018
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Practice location Address checks out

2064 Lilac Arbor Way
Dacula, GA 30019-2475
Phone: (678) 887-4367
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 147685 (GA)

Record details

NPI number1164920716
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 29, 2018
Last updated in NPPESJuly 20, 2021
Certification dateJuly 20, 2021
Mailing address2064 Lilac Arbor Way, Dacula, GA 30019-2475

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Dacula