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:
Health care specialties
| Specialty | Code | License # | 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 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891796595 | NPPES |
| Idaho | MEDICAID | 807178100 |
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