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General NPI Number Information
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NPI Number | 1124291927
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Entity Type | Organization
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Legal Business Name | WELLNESS PRIMARY CARE, LLC
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Dates
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Enumeration Date | 04/12/2008
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 5456 JIMMY CARTER BLVD SUITE 240
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City | NORCROSS
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State | GA
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Zip | 30093-1511
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Country | US
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Telephone | 678-380-9889
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Fax |
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Provider Business Mailing Address
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Address Line | 5456 JIMMY CARTER BLVD SUITE 240
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City | NORCROSS
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State | GA
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Zip | 30093-1511
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Country | US
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Telephone | 678-380-9889
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PAUL HUY-DAO NGUYEN
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Credential | M.D.,
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Telephone | 678-380-9889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 047813
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License Number State | GA
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