Healthcare Provider Details

I. General information

NPI: 1780263343
Provider Name (Legal Business Name): THANH NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 NORTH AVE NE APT 3126
ATLANTA GA
30308-3070
US

IV. Provider business mailing address

641 NORTH AVE NE APT 3126
ATLANTA GA
30308-3070
US

V. Phone/Fax

Practice location:
  • Phone: 281-515-3315
  • Fax:
Mailing address:
  • Phone: 281-515-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number16168
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number16168
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: