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General NPI Number Information
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NPI Number | 1861811572
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Entity Type | Organization
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Legal Business Name | BUCKHEAD PRIMARY CARE, LLC
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 1891 HOWELL MILL RD NW SUITE A
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City | ATLANTA
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State | GA
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Zip | 30318
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Country | US
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Telephone | 678-515-0688
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Fax | 404-829-2380
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Provider Business Mailing Address
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Address Line | 2897 N FULTON DR
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City | ATLANTA
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State | GA
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Zip | 30305
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Country | US
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Telephone | 678-515-0688
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Fax | 404-829-2380
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Authorized Official
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Title or Position | PRESIDENT
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Name | THINH DUC NGUYEN
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Credential | M.D.
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Telephone | 678-515-0688
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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 | 062402
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License Number State | GA
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