MEDICARE: DR. CECILE Q. NGUYEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	039644	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609819283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CECILE Q. NGUYEN MD

Provider Business Mailing Address
First Line	:	PO BOX 229
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30224-0006
Country	:	US
Telephone Number	:	404-766-4633
Fax Number	:	404-766-1108

Provider Business Practice Location Address
First Line	:	1029 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344
Country	:	US
Telephone Number	:	404-766-4633
Fax Number	:	404-766-1108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	10/07/2010

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