SHANE C MANGRUM (NPI# 1891796595) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891796595 |
| Entity Type | Individual |
| Full Name | SHANE C MANGRUM |
| Credential | M.D. |
| Practice Address |
1150 Hammond Dr Suite 400 Atlanta GA 30328-5334 |
| Practice Telephone | 4042562633 |
| Practice Fax Number | 4042556532 |
| Mailing Telephone | 4042562633 |
| Mailing Fax Number | 4042556532 |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2015-04-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
73026 | GA | Allopathic & Osteopathic Physicians |
| N | 225400000X | Rehabilitation Practitioner | M9189 | ID | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 807178100 | 05 |
| Street Address |
1150 HAMMOND DR SUITE 400 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30328-5334 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063947182 | Michael A Bens Dmd PC | Dentist | 1150 Hammond Dr, Suite 225, Atlanta, GA 30328-5334 | 2017-04-26 |
| 1558803486 | North Atlanta Primary Care | Physician Assistant | 1150 Hammond Dr, Atlanta, GA 30328-5334 | 2016-11-09 |
| 1346612009 | Stellar Ambulatory Anesthesia Consultants, LLC | Anesthesiology | 1150 Hammond Dr, Bldg E, Suite 600, Atlanta, GA 30328-5334 | 2015-10-21 |
| 1124034913 | Michael Allen Bens | Dentist | 1150 Hammond Dr, Bldg. E, Suite 225, Atlanta, GA 30328-5334 | 2006-07-31 |
| 1881668762 | Zale Smilack Dds PC | Dentist | 1150 Hammond Dr, Ste C-3150, Atlanta, GA 30328-8120 | 2006-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467910042 | Amber Andrews | Behavior Technician | 750 Hammond Drive Bldg 7 Suite 100, Atlanta, GA 30328 | 2019-03-04 |
| 1215492830 | Ryan William Dubinin | Behavior Technician | 750 Hammond Drive, Building 7, Suite 100, Atlanta, NJ 30328 | 2019-02-07 |
| 1346710142 | Emily Rose Lloyd Swavely | Speech-Language Pathologist | 5825 Glenridge Rd., Building 1, Suite 133, Atlanta, GA 30328 | 2018-12-05 |
| 1063994481 | Mark Edward Brachmanski | Optometrist | 800 Mount Vernon Highway Ne, Suite 130, Atlanta, GA 30328 | 2018-09-01 |
| 1407352578 | Nina Brown | Massage Therapist | 7100 Peachtree Dunwoody Rd Ste 110, Sandy Springs, GA 30328 | 2018-04-05 |
| 1336657741 | Renee Usher Reeves | Assistant Behavior Analyst | 750 Hammond Dr Building 7, Suite 100, Atlanta, GA 30328 | 2018-01-19 |
| 1487168274 | Patricia Nicole Felder | Student in an Organized Health Care Education/Training Program | 270 Carpenter Dr, Ne, Suite # 400, Atlanta, GA 30328 | 2017-12-01 |
| 1447762927 | Ponders Podiatry LLC | Podiatrist | 275 Carpenter Drive Ne, Suite 106, Atlanta, GA 30328 | 2017-10-24 |
| 1770093601 | Syed M Rasheed | Physician Assistant | 5788 Roswell Rd Ste 100, Atlanta, GA 30328 | 2017-10-05 |
| 1437678190 | Jeanette Denise Jones | Counselor | 270 Carpenter Drive, Suite 400, Sandy Springs, GA 30328 | 2017-09-13 |
| Find all providers in zip 30328 | ||||
| Taxonomy Code | 2081P2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pain Medicine |
| A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760900708 | Neuro Diagnostic Group LLC | Physical Medicine & Rehabilitation | 200 Galleria Pkwy Se Ste 100, Atlanta, GA 30339-5944 | 2017-08-30 |
| 1073812335 | Mikhail Zhukalin | Physical Medicine & Rehabilitation | 1648 Pierce Dr. Ne, Atlanta, GA 30307 | 2011-03-24 |
| 1669690723 | Injury Centers of Atlanta L.l.c | Physical Medicine & Rehabilitation | 4186 Buford Hwy Ne Ste F, Atlanta, GA 30345-1067 | 2007-04-23 |
| 1821113556 | Med Health Services LLC | Physical Medicine & Rehabilitation | 4780 Ashford Dunwoody Road, Ste A418, Atlanta, GA 30338-5504 | 2007-03-20 |
| 1659409860 | Vita Life Medical LLC | Physical Medicine & Rehabilitation | 2870 Peachtree Rd Ne, Ste 431, Atlanta, GA 30305 | 2007-03-01 |
| 1518568591 | Atlanta Spine, PC | Physical Medicine & Rehabilitation | 755 Mount Vernon Hwy Ne Ste 305, Atlanta, GA 30328-4290 | 2020-11-05 |
| 1629688114 | Prm of Georgia PC | Physical Medicine & Rehabilitation | 371 E Paces Ferry Rd Ne Ste 730, Atlanta, GA 30305-2372 | 2020-08-09 |
| 1316507775 | Atlanta Spine, PC | Physical Medicine & Rehabilitation | 60 Peachtree Park Dr Ne Ste 200, Atlanta, GA 30309-1304 | 2019-06-18 |
| 1295197036 | Chelsea Denise Frost | Physical Medicine & Rehabilitation | 59 Executive Park South Ne, Atlanta, GA 30329-2208 | 2016-03-22 |
| 1063766160 | Thomas H Xu | Physical Medicine & Rehabilitation | 2001 Peachtree Rd Ne Ste 550, Atlanta, GA 30309-1416 | 2012-10-29 |
| Find all providers in ATLANTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.