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General NPI Number Information
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NPI Number | 1710582374
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Entity Type | Individual
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Provider Name | NHAN QUANG NGO
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Gender | Male
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 2795 CHASTAIN MEADOWS PKWY
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City | MARIETTA
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State | GA
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Zip | 30066-3361
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Country | US
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Telephone | 770-427-2480
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Fax | 770-427-7661
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Provider Business Mailing Address
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Address Line | 3204 SUMMER STREAM LN NW
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City | KENNESAW
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State | GA
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Zip | 30152-5881
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Country | US
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Telephone | 678-790-9905
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH026412
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License Number State | GA
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