Healthcare Provider Details

I. General information

NPI: 1982960118
Provider Name (Legal Business Name): WANJA E MWANGI MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 MILSTEAD AVE NE
CONYERS GA
30012-3877
US

IV. Provider business mailing address

660 RALPH MCGILL BLVD NE APT 3218
ATLANTA GA
30312-1158
US

V. Phone/Fax

Practice location:
  • Phone: 770-918-3030
  • Fax:
Mailing address:
  • Phone: 706-224-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number76118
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number76118
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: