Healthcare Provider Details

I. General information

NPI: 1558066647
Provider Name (Legal Business Name): BAO MINH NGUYEN DO, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W 3RD AVE
ALBANY GA
31701-1943
US

IV. Provider business mailing address

522 STOCKS DAIRY RD
LEESBURG GA
31763-3053
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-1000
  • Fax:
Mailing address:
  • Phone: 678-906-5368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number110841
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: