Healthcare Provider Details

I. General information

NPI: 1881964096
Provider Name (Legal Business Name): GIAO CHAU NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 RIVERWALK PL
MEMPHIS TN
38103-0845
US

IV. Provider business mailing address

136 RIVERWALK PL
MEMPHIS TN
38103-0845
US

V. Phone/Fax

Practice location:
  • Phone: 703-622-4685
  • Fax:
Mailing address:
  • Phone: 703-622-4685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number48128
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberC180771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: