Healthcare Provider Details

I. General information

NPI: 1467275396
Provider Name (Legal Business Name): CINDY THANH-THANH PHAM VO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY VO PA-C

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E CROSSVILLE RD STE 210
ROSWELL GA
30075-7661
US

IV. Provider business mailing address

5026 ASH ST
FOREST PARK GA
30297-2332
US

V. Phone/Fax

Practice location:
  • Phone: 770-510-1850
  • Fax:
Mailing address:
  • Phone: 404-769-4337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13858
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: