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Individual

DR. CHARLITA MANGRUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1021 W HAMLET AVE, SUITE#5, HAMLET, NC 28345-4523
(910) 582-5166
(910) 582-5168
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200401535
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
138KX
BCBS INDIV
NC
01
89016EO
CAROLINA ACCESS
NC
05
89138KX
NC
05
N01535
SC
01
P00267476
RAILROAD MEDICARE
NC
01
P00687321
RR MEDICARE
NC
Enumeration date
10/13/2005
Last updated
06/09/2009
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