Mangrum, Shane C

Mangrum, Shane C is an individual health care provider with primary practice located at 1150 Hammond Dr Suite 400, Atlanta GA 30328-5334. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Rehabilitation Practitioner, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Mangrum, Shane C can be contacted via phone (404) 256-2633.

Contact Information

Primary practice address
1150 Hammond Dr Suite 400 Atlanta GA 30328-5334
Phone: (404) 256-2633
Fax: (404) 255-6532
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Rehabilitation Practitioner 225400000X M9189 Idaho
Allopathic & Osteopathic Physicians / Pain Medicine 2081P2900X 73026 Georgia

Profile Details

NPI number 1891796595
LBN Legal business name Mangrum, Shane C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 3rd, 2005
Last updated Apr 14th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891796595 NPPES
Idaho MEDICAID 807178100

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