=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548127111
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THAO P PHAM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2026
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2618 SABLE GLEN CT
-----------------------------------------------------
City | BUFORD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30519-7663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-936-6625
-----------------------------------------------------
Fax | 470-326-3999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2618 SABLE GLEN CT
-----------------------------------------------------
City | BUFORD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30519-7663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-936-6625
-----------------------------------------------------
Fax | 470-326-3999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN304886
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------