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General NPI Number Information
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NPI Number | 1639379746
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Entity Type | Individual
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Provider Name | SON THANH NGUYEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 1233 SHOREHAM DR
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5845
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Country | US
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Telephone | 770-313-7229
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Fax |
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Provider Business Mailing Address
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Address Line | 132 FRANKLIN SPRINGS ST
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City | ROYSTON
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State | GA
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Zip | 30662-4134
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Country | US
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Telephone | 770-313-7229
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 059834
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License Number State | GA
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