MEDICARE: JEANIE NGUYEN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	290029	GA
2	363L00000X	Nurse Practitioner	29987	SC
3	163W00000X	Registered Nurse	RN290029	GA

General Provider Information

NPI Number	:	1194436717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANIE NGUYEN NP

Provider Business Mailing Address
First Line	:	3200 COBB GALLERIA PKWY STE 205
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5919
Country	:	US
Telephone Number	:	678-888-3223
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 COBB GALLERIA PKWY STE 205
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5919
Country	:	US
Telephone Number	:	678-888-3223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	04/07/2026

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Directions to “ JEANIE NGUYEN NP” Practice Location

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