Healthcare Provider Details

I. General information

NPI: 1154475911
Provider Name (Legal Business Name): AILEEN TIEU HUYNH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

710 CENTER ST
COLUMBUS GA
31901-1527
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1454
  • Fax: 706-660-2750
Mailing address:
  • Phone: 706-571-1454
  • Fax: 706-660-2750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number058873
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: