=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083580492
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CUMMING RHEUMATOLOGY AND ARTHRITIS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2025
-----------------------------------------------------
Last Update Date | 10/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3970 DEPUTY BILL CANTRELL MEM # 203
-----------------------------------------------------
City | CUMMING
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30040-3069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-887-5159
-----------------------------------------------------
Fax | 770-887-9496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3970 DEPUTY BILL CANTRELL MEM # 203
-----------------------------------------------------
City | CUMMING
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30040-3069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-887-5159
-----------------------------------------------------
Fax | 770-887-9496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JAGINDRA N MANGRU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 770-887-5159
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------