Healthcare Provider Details

I. General information

NPI: 1063553501
Provider Name (Legal Business Name): N.D. LIEN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4865 LAVISTA RD SUITE A
TUCKER GA
30084-4436
US

IV. Provider business mailing address

PO BOX 29528
ATLANTA GA
30359-0528
US

V. Phone/Fax

Practice location:
  • Phone: 770-270-0290
  • Fax: 770-723-0598
Mailing address:
  • Phone: 770-270-0290
  • Fax: 770-723-0598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number024046
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036656
License Number StateGA

VIII. Authorized Official

Name: LIEN DUC NGUYEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 770-270-0290