Healthcare Provider Details

I. General information

NPI: 1356090724
Provider Name (Legal Business Name): IVA HU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CRESCENT CENTER PKWY
TUCKER GA
30084-7047
US

IV. Provider business mailing address

200 CRESCENT CENTER PKWY
TUCKER GA
30084-7047
US

V. Phone/Fax

Practice location:
  • Phone: 954-724-6540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number112333
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: