Individual
COKESHIA MANGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW
Contact information
Practice address
192 BOWLES ST SW, BACONTON, GA 31716-7648
(229) 407-2962
Mailing address
192 BOWLES ST SW, BACONTON, GA 31716-7648
(229) 407-2962
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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