Healthcare Provider Details

I. General information

NPI: 1942122635
Provider Name (Legal Business Name): TIMOTHY NGUYEN DO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6319 JONESBORO RD STE A
MORROW GA
30260-1786
US

IV. Provider business mailing address

3833 SHADOW LOCH DR
SUWANEE GA
30024-7066
US

V. Phone/Fax

Practice location:
  • Phone: 770-703-4205
  • Fax:
Mailing address:
  • Phone: 404-641-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124292
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: