MEDICARE: CUMMING RHEUMATOLOGY AND ARTHRITIS LLC

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	261QM2500X	Medical Specialty Clinic/Center	62253	GA

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

General Provider Information

NPI Number	:	1992014872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUMMING RHEUMATOLOGY AND ARTHRITIS LLC

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 MEM
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	:	PHYSICIAN
Name	:	DR. JAGINDRA NATH MANGRU
Credential	:	M.D.
Telephone Number	:	770-887-5159

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	01/21/2020

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