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General NPI Number Information
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NPI Number | 1902210750
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Entity Type | Individual
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Provider Name | NGHIA PHAM D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 5430 JIMMY CARTER BLVD STE 200
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City | NORCROSS
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State | GA
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Zip | 30093-1506
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Country | US
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Telephone | 678-310-4206
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 SWEETWATER RD UNIT 126
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City | DULUTH
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State | GA
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Zip | 30096-4766
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Country | US
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Telephone | 404-593-9739
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR009249
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License Number State | GA
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