Healthcare Provider Details

I. General information

NPI: 1750989810
Provider Name (Legal Business Name): TRANG KHANH NGUYEN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2258 WRIGHTSBORO RD
AUGUSTA GA
30904-4887
US

IV. Provider business mailing address

PO BOX 925
AUGUSTA GA
30903-0925
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-4400
  • Fax: 706-724-6003
Mailing address:
  • Phone: 706-854-6008
  • Fax: 706-854-6946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN246685
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: