Healthcare Provider Details

I. General information

NPI: 1861449589
Provider Name (Legal Business Name): TAN-LOC P NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 N HOUSTON RD
WARNER ROBINS GA
31093-1505
US

IV. Provider business mailing address

1025 N HOUSTON RD
WARNER ROBINS GA
31093-1505
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-9136
  • Fax: 478-923-6846
Mailing address:
  • Phone: 478-922-9136
  • Fax: 478-923-6846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number52213
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: