Healthcare Provider Details

I. General information

NPI: 1821709262
Provider Name (Legal Business Name): CHAMBLEE FAMILY MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 03/12/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4897 BUFORD HWY STE 167
CHAMBLEE GA
30341-3670
US

IV. Provider business mailing address

4897 BUFORD HWY STE 167
CHAMBLEE GA
30341-3670
US

V. Phone/Fax

Practice location:
  • Phone: 770-872-8141
  • Fax: 770-872-8142
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VINCENT CHI NGUYEN
Title or Position: DNP-C
Credential: DNP-C
Phone: 770-872-8141