Healthcare Provider Details

I. General information

NPI: 1285945428
Provider Name (Legal Business Name): JONATHAN HUY NGUYEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

720 WESTVIEW DR SW HARRIS BUILDING, SUITE 100-A
ATLANTA GA
30310-1458
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-1000
  • Fax:
Mailing address:
  • Phone: 404-756-1400
  • Fax: 404-756-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number208D00000X
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number076300
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: