Healthcare Provider Details

I. General information

NPI: 1447945167
Provider Name (Legal Business Name): SOPHIA THUY VI LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA THUY VI BRUNE-HERRERA LE FNP

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192 ROCKBRIDGE RD STE A
STONE MOUNTAIN GA
30087-2923
US

IV. Provider business mailing address

704 ZOYSIA LN
LAWRENCEVILLE GA
30046-6061
US

V. Phone/Fax

Practice location:
  • Phone: 770-925-2010
  • Fax:
Mailing address:
  • Phone: 404-451-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN279397
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: