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Individual

DR. SHAANTA A. HANAGUD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
200 CRESCENT CENTER PKWY, TUCKER, GA 30084-7047
(770) 496-3626
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1717
(404) 364-7070

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
056456
GA
207Q00000X
Family Medicine Physician
MD-11650
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00C0230270
HMSA BILLING NUMBER
HI
05
501975-05
HI
Enumeration date
10/03/2006
Last updated
01/07/2022
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