Individual
SHANE C MANGRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1150 HAMMOND DR, SUITE 400, ATLANTA, GA 30328-5334
(404) 256-2633
(404) 255-6532
Mailing address
1150 HAMMOND DR, SUITE 400, ATLANTA, GA 30328-5334
(404) 256-2633
(404) 255-6532
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
73026
GA
225400000X
Rehabilitation Practitioner
M9189
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807178100
—
ID
Enumeration date
08/03/2005
Last updated
02/12/2026
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