Individual provider · NPI-1

Dr. Shantae Mangaroo, M.D.

Family Medicine · Lithonia, GA

NPI number1902293434

StatusActive

Last updated in NPPESApr 14, 2022

Details

NPI: 1902293434
Entity type: Individual (NPI-1)
Name: Dr. Shantae Mangaroo
Credential: M.D.
Sex: Female
Sole proprietor: Yes
Enumeration date: Apr 22, 2015
Certification date: Apr 14, 2022
Last updated: Apr 14, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207Q00000X	Family Medicine	80684	GA	Yes
390200000X	Student in an Organized Health Care Education/Training Program	–	–

Practice location

8011 Mall Pkwy
Lithonia, GA 30038

Phone 404-518-8056

Mailing address

8011 Mall Pkwy
Lithonia, GA 30038-2543

Phone 404-518-8056

Other practice locations

720 Westview Dr Sw
Atlanta, GA 30310-1458

Phone 404-752-1500

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