Healthcare Provider Details

I. General information

NPI: 1962970525
Provider Name (Legal Business Name): TONY NGUYEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2253 NORTHWEST PKWY SE
MARIETTA GA
30067-8764
US

IV. Provider business mailing address

576 FRANCIS PL SW
LILBURN GA
30047-4108
US

V. Phone/Fax

Practice location:
  • Phone: 678-647-8692
  • Fax:
Mailing address:
  • Phone: 770-778-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCHIR010144
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberCHIR010144
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCHIR010144
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHIR010144
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberCHIR010144
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberCHIR010144
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR010144
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIR010144
License Number StateGA
# 9
Primary TaxonomyN
Taxonomy Code111NT0100X
TaxonomyThermography Chiropractor
License NumberCHIR010144
License Number StateGA
# 10
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberCHIR010144
License Number StateGA
# 11
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCHIR010144
License Number StateGA
# 12
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010144
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: