Individual
TYRONE MANGUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7136 TANGER BLVD, RIVERDALE, GA 30296-6072
(919) 812-8441
Mailing address
7136 TANGER BLVD, RIVERDALE, GA 30296-6072
Taxonomy
Speciality
Code
Description
License number
State
171R00000X
Interpreter
Primary
—
—
171W00000X
Contractor
—
—
Other
Enumeration date
03/01/2025
Last updated
03/01/2025
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