Timothy Mangum Jr.

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

72050 Issued in TX

Practice address

215 Westlake Dr
Sandersville, GA 31082-9427

Phone

(919) 810-3283

NPI assigned

Dec 9, 2024

Last updated

Dec 9, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1902612468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 WESTLAKE DR",
            "city": "SANDERSVILLE",
            "state": "GA",
            "postal_code": "310829427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 WESTLAKE DR",
            "city": "SANDERSVILLE",
            "state": "GA",
            "postal_code": "310829427",
            "telephone_number": "919-810-3283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGUM",
        "first_name": "TIMOTHY",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-12-09",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NC",
            "license": "1297566",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "SC",
            "license": "324407",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NV",
            "license": "233771",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "GA",
            "license": "1962506",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "TX",
            "license": "72050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colieus Darel Lawson
• Sandy Drew Carter Lewis
• Timyrius Tyrell Lewis, RN
• Geordan Cullens Lynch, CRNA
• Ashunti Drummond Lyons, LMSW
• Patti Lorri Marat, RN MSN APRN NP-C
• Mark R Harvey MD PC
• Gina Nicole McClarin, FNP-BC
• Edward Chandler McDavid, MD
• Lisa G McDonald, RPH, CDM

• School Psychologist in Sandersville, GA
• Providers in Sandersville, GA by specialty
• School Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.