Individual
TIMOTHY C MANGRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4230 HARDING RD, SUITE 400, NASHVILLE, TN 37205-2013
(615) 297-2700
(615) 269-4584
Mailing address
104 WOODMONT BLVD, SUITE LL50, NASHVILLE, TN 37205-2245
(615) 386-2300
(615) 386-2399
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27482
TN
208000000X
Pediatrics Physician
027482
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01047325
AMERIGROUP-MCD
TN
01
—
12459471
MULTIPLAN/PHCS
TN
01
—
1735352
UNITED HEALTH CARE
TN
01
—
2790831
COVENTRY/FIRST HEALTH
TN
05
—
3801962
—
TN
01
—
4085154
BLUE CROSS OF TN
TN
01
—
5389663
AETNA
TN
01
—
549809
USA - MCO
TN
05
—
71000102000
—
KY
01
—
P00103889
MEDICARE RR
TN
Enumeration date
06/05/2006
Last updated
05/07/2015
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