MEDICARE: DR. JAGINDRA N MANGRU MD

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	207RR0500X	Rheumatology Physician	38156	TN
2	207RR0500X	Rheumatology Physician	062253	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00222697	OTHER	TN	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4092108	OTHER	TN	BLUE CROSS NUMBER
4	TN0105	OTHER	TN	JOHN DEERE

General Provider Information

NPI Number	:	1922028034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAGINDRA N MANGRU MD

Provider Business Mailing Address
First Line	:	3970 DEPUTY BILL CANTRELL MEM
Second Line	:	STE 203
City	:	CUMMING
State	:	GA
Zip	:	30040-5962
Country	:	US
Telephone Number	:	770-887-5159
Fax Number	:	770-887-9496

Provider Business Practice Location Address
First Line	:	3970 DEPUTY BILL CANTRELL MEMORIAL ROAD
Second Line	:	STE 203
City	:	CUMMING
State	:	GA
Zip	:	30040-3004
Country	:	US
Telephone Number	:	770-887-5159
Fax Number	:	770-887-9496

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/23/2020

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Directions to “ DR. JAGINDRA N MANGRU MD” Practice Location

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