Individual
CAROLE L MANGREM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2245 N STARTE ST, CLARKSDALE, MS 38614
(662) 627-4131
(662) 627-2702
Mailing address
PO BOX 1447, CLARKSDALE, MS 38614-1447
(662) 627-4131
(662) 627-2702
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
07191
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114140
—
MS
Enumeration date
03/13/2007
Last updated
07/08/2007
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