Healthcare Provider Details

I. General information

NPI: 1245324615
Provider Name (Legal Business Name): HOANG TRAN LAFAYETTE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W DOUBLEGATE DR
ALBANY GA
31721-9234
US

IV. Provider business mailing address

2600 W DOUBLEGATE DR
ALBANY GA
31721-9234
US

V. Phone/Fax

Practice location:
  • Phone: 229-436-3056
  • Fax: 229-436-3056
Mailing address:
  • Phone: 229-436-3056
  • Fax: 229-436-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000760
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: