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General NPI Number Information
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NPI Number | 1255084653
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Entity Type | Individual
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Provider Name | DIEU LIEN THI QUACH AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 595 HURRICANE SHOALS RD NW
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8761
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Country | US
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Telephone | 404-645-7150
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Fax |
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Provider Business Mailing Address
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Address Line | 383 OLDE EASTLEIGH CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-6071
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Country | US
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Telephone | 678-559-2043
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN215863
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AG03260056
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License Number State | GA
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