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General NPI Number Information
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NPI Number | 1205332798
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Entity Type | Individual
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Provider Name | PHI V NGUYEN MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 4864 JACKSON STREET FAMILY MEDICINE
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-330-7164
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 MOUNT ZION PKWY
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City | JONESBORO
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State | GA
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Zip | 30236-2500
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Country | US
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Telephone | 318-330-7164
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 88303
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License Number State | GA
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