Basic Information
| Provider Information | |||||||||
| NPI: | 1851937213 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MWANGI | ||||||||
| FirstName: | STELLA | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 JOHNSON FERRY RD STE 600 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042564777 | ||||||||
| FaxNumber: | 4042565515 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 JOHNSON FERRY RD STE 600 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042564777 | ||||||||
| FaxNumber: | 4042565515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2019 | ||||||||
| LastUpdateDate: | 11/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | RN205334 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363L00000X | RN205334 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 003233370A | 05 | GA | MEDICAID | G19712A | 01 | GA | MEDICARE PTAN | OTHER |