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General NPI Number Information
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NPI Number | 1164657821
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Entity Type | Individual
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Provider Name | THANG XUAN NGUYEN MD
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Gender | Male
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 1360 S MAIN ST
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City | ELLIJAY
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State | GA
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Zip | 30540-5410
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Country | US
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Telephone | 706-515-4038
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Fax |
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Provider Business Mailing Address
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Address Line | 404 AFTER GLOW SMT
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City | CANTON
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State | GA
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Zip | 30114-5715
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Country | US
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Telephone | 212-479-9566
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 27172
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License Number State | OK
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