Individual
DR. JAGINDRA N MANGRU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3970 DEPUTY BILL CANTRELL MEMORIAL ROAD, STE 203, CUMMING, GA 30040-3004
(770) 887-5159
(770) 887-9496
Mailing address
3970 DEPUTY BILL CANTRELL MEM, STE 203, CUMMING, GA 30040-5962
(770) 887-5159
(770) 887-9496
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
062253
GA
207RR0500X
Rheumatology Physician
38156
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33396001
—
TN
01
—
4092108
BLUE CROSS NUMBER
TN
01
—
P00222697
MEDICARE RAILROAD
TN
01
—
TN0105
JOHN DEERE
TN
Enumeration date
07/20/2006
Last updated
01/23/2020
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