Provider Demographics
NPI:1336658327
Name:MWANGI, ANTONY IRUNGU (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:ANTONY
Middle Name:IRUNGU
Last Name:MWANGI
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 THICKET PATH NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-7966
Mailing Address - Country:US
Mailing Address - Phone:770-933-9300
Mailing Address - Fax:
Practice Address - Street 1:4812 THICKET PATH NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-7966
Practice Address - Country:US
Practice Address - Phone:770-933-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY