Healthcare Provider Details

I. General information

NPI: 1740120674
Provider Name (Legal Business Name): ANDREW THANH NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MOREHEAD MEDICAL DR STE 300
CHARLOTTE NC
28204-2966
US

IV. Provider business mailing address

1025 MOREHEAD MEDICAL DR STE 300
CHARLOTTE NC
28204-2966
US

V. Phone/Fax

Practice location:
  • Phone: 704-446-2772
  • Fax: 704-355-2467
Mailing address:
  • Phone: 704-446-2772
  • Fax: 704-355-2467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: