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General NPI Number Information
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NPI Number | 1538801394
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Entity Type | Individual
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Provider Name | QUANG HUY VU TRAN
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Gender | Male
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 605 BEAVER RUIN RD NW STE C
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City | LILBURN
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State | GA
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Zip | 30047-3430
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Country | US
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Telephone | 573-821-0352
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Fax |
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Provider Business Mailing Address
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Address Line | 1157 HALLETTS PEAK PL
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-0105
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Country | US
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Telephone | 404-723-3471
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10972
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License Number State | GA
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