MEDICARE: JESSICA MARIE MANGANO MED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	7291	TN

General Provider Information

NPI Number	:	1124868195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE MANGANO MED

Provider Business Mailing Address
First Line	:	4730 BRIARWOOD DR
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37416-3114
Country	:	US
Telephone Number	:	317-629-7227
Fax Number	:

Provider Business Practice Location Address
First Line	:	6216 DAYTON BLVD STE D
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-2766
Country	:	US
Telephone Number	:	423-521-5126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	05/28/2024

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Directions to “ JESSICA MARIE MANGANO MED” Practice Location

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