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Individual

DR. SHANTAE MANGAROO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
8011 MALL PKWY, LITHONIA, GA 30038
(404) 518-8056
Mailing address
8011 MALL PKWY, LITHONIA, GA 30038-2543
(404) 518-8056

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
80684
GA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
04/22/2015
Last updated
04/14/2022
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