Healthcare Provider Details

I. General information

NPI: 1396279030
Provider Name (Legal Business Name): JACINTA PHUONG TRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACINTA PHUONG NGUYEN MD

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 JESSE JEWELL PKWY STE 102
GAINESVILLE GA
30501-3806
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-9446
  • Fax:
Mailing address:
  • Phone: 770-848-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number86580
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: