Healthcare Provider Details

I. General information

NPI: 1700071156
Provider Name (Legal Business Name): DUC QUANG TRAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE STE 1090
ATLANTA GA
30308-2232
US

IV. Provider business mailing address

550 PEACHTREE ST NE STE 1090
ATLANTA GA
30308-2232
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-3494
  • Fax:
Mailing address:
  • Phone: 404-686-3494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME104476
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN9842
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number65192
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: