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General NPI Number Information
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NPI Number | 1922028034
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Entity Type | Individual
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Provider Name | JAGINDRA N MANGRU MD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 3970 DEPUTY BILL CANTRELL MEMORIAL ROAD STE 203
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City | CUMMING
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State | GA
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Zip | 30040-3004
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Country | US
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Telephone | 770-887-5159
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Fax | 770-887-9496
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Provider Business Mailing Address
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Address Line | 3970 DEPUTY BILL CANTRELL MEM STE 203
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City | CUMMING
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State | GA
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Zip | 30040-5962
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Country | US
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Telephone | 770-887-5159
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Fax | 770-887-9496
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 38156
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 062253
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License Number State | GA
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