Cokeshia Mango, BSW
Individual provider Active NPI Contractor · Baconton, GA
NPI 1013510429 · NPPES record last updated Nov 18, 2020
Key facts
- NPI
- 1013510429
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 192 Bowles St SW
Baconton, GA 31716-7648 - Phone
- (229) 407-2962
- NPI assigned
- Nov 18, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
192 Bowles St SW
Baconton, GA 31716-7648
Mailing address
192 Bowles St SW
Baconton, GA 31716-7648
Phone (229) 407-2962
Other providers in Baconton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.