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Individual
MR. CARL H MANGUM
Active
Individual
MR. CARL H MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, NP, RN
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2012015018
MS
Other
Enumeration date
04/22/2015
Last updated
06/03/2015
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