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General NPI Number Information
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NPI Number | 1750096103
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Entity Type | Individual
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Provider Name | JENNIFER NGUYEN LE PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 2690 HAMILTON MILL RD STE 100
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City | BUFORD
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State | GA
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Zip | 30519-4193
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Country | US
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Telephone | 470-326-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 NOBLE VINES DR APT 1204
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City | BUFORD
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State | GA
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Zip | 30519-6112
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Country | US
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Telephone | 404-518-5064
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11342
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License Number State | GA
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