MEDICARE: THIEN-KIM PHAN LE MD

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	207Q00000X	Family Medicine Physician	77286	GA

General Provider Information

NPI Number	:	1508283789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THIEN-KIM PHAN LE MD

Provider Business Mailing Address
First Line	:	740 RALPH MCGILL BLVD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-1118
Country	:	US
Telephone Number	:	404-251-1740
Fax Number	:	404-332-3384

Provider Business Practice Location Address
First Line	:	740 RALPH MCGILL BLVD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-1118
Country	:	US
Telephone Number	:	404-251-1740
Fax Number	:	404-332-3384

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

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	07/21/2022

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