Provider Demographics
NPI:1538846985
Name:MANGHRAM, SHONTASHA (MSW)
Entity type:Individual
Prefix:
First Name:SHONTASHA
Middle Name:
Last Name:MANGHRAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 WANDA WAY APT L
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-2750
Mailing Address - Country:US
Mailing Address - Phone:478-244-4375
Mailing Address - Fax:
Practice Address - Street 1:237 WANDA WAY APT L
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-2750
Practice Address - Country:US
Practice Address - Phone:478-244-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor