Healthcare Provider Details

I. General information

NPI: 1396279030
Provider Name (Legal Business Name): JACINTA PHUONG TRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACINTA PHUONG NGUYEN MD

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 N HOUSTON RD SUITE 140E
WARNER ROBINS GA
31093
US

IV. Provider business mailing address

1601 WATSON BLVD
WARNER ROBINS GA
31093-3431
US

V. Phone/Fax

Practice location:
  • Phone: 478-975-6880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number86580
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: