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General NPI Number Information
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NPI Number | 1639296569
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Entity Type | Individual
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Provider Name | HUNG THIEN LY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1393 US HIGHWAY 80 E
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City | POOLER
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State | GA
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Zip | 31322-8901
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Country | US
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Telephone | 912-964-0108
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31096
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City | SAVANNAH
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State | GA
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Zip | 31410-8196
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Country | US
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Telephone |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | GA047797
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License Number State | GA
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