| Doctor Name: | MS. CANDACE D MANGUM |
| NPI Number: | 1407924384 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | 1-090975 |
| Business Practice Address: | 56 West Main Street Notasulga, AL - 368660100 |
| Business Phone Number: | 3342571081 |
| Business Fax Number: | 3342571086 |
| Mailing Address: | Po Box 100, NOTASULGA |
| State: | AL |
| Postal Code: | 368660100 |
| Phone Number: | 3342571081 |
| Fax Number: | 3342571086 |
| NPI Enumeration Date: | 12/01/2006 |
| NPI Last Update Date: | 06/08/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | 1-090975 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |