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Contact Information

SHANE C MANGRUM, MD
1150 HAMMOND DR
SUITE 400
ATLANTA, GA30328-5334
 Phone: 404-256-2633
 Fax: 404-255-6532
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pain Medicine

2081P2900X 25 Physician/Physical Medicine and Rehabilitation
 

Rehabilitation Practitioner

225400000X
Indicates primary specialty

NPI Profile & details for SHANE C MANGRUM · (Male)

NPI Number 1891796595
Status Active
Credentials MD
Entity Individual
Enumeration date 08/03/2005
Last updated 02/12/2026 - About 4 months ago
Sole proprietor 1 No
Identifiers
  • GA License # 73026
  • ID License # M9189
  • ID Medicaid 807178100
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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