Active NPI
Paul Daniel Mangum, PH.D
- Clinical Psychologist
- Athens, GA
National Provider Identifier
1598801052
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Nov 18, 2010.
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 526
- Practice address
- 1150 S Milledge Ave
#3
Athens, GA 30605-6723 - Phone
- (706) 546-0255
- Fax
- (706) 548-6648
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 526 | GA | Primary |
Addresses
Primary practice location
1150 S Milledge Ave
#3
Athens, GA 30605-6723
Mailing address
1150 S Milledge Ave
#3
Athens, GA 30605-6723
Phone (706) 546-0255
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 526 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1598801052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1150 S MILLEDGE AVE",
"address_2": "#3",
"city": "ATHENS",
"state": "GA",
"postal_code": "306056723",
"telephone_number": "706-546-0255",
"fax_number": "706-548-6648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1150 S MILLEDGE AVE",
"address_2": "#3",
"city": "ATHENS",
"state": "GA",
"postal_code": "306056723",
"telephone_number": "706-546-0255",
"fax_number": "706-548-6648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGUM",
"first_name": "PAUL",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "526",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.