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General NPI Number Information
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NPI Number | 1821082421
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Entity Type | Individual
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Provider Name | KHOA DANG NGUYEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 1499 FAIR ROAD
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City | STATESBORO
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State | GA
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Zip | 30458
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Country | US
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Telephone | 912-486-1533
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Fax | 912-871-2396
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Provider Business Mailing Address
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Address Line | P.O. BOX 3578
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City | AUGUSTA
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State | GA
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Zip | 30914-3578
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Country | US
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Telephone | 706-737-4575
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Fax | 706-731-5289
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 053793
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 053793
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | 053793
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | 053793
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 053793
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 53793
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 053793
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License Number State | GA
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Taxonomy #8
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 053793
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License Number State | GA
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Taxonomy #9
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25IA12514200
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License Number State | NJ
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Taxonomy #10
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 53793
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License Number State | GA
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