MEDICARE: DAT M NGUYEN PA-C

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	363A00000X	Physician Assistant	9632	GA
2	2086S0129X	Vascular Surgery Physician	9632	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA14510	OTHER	TX	TEXAS MEDICAL BOARD

General Provider Information

NPI Number	:	1588294441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAT M NGUYEN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 PEACHTREE RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1281
Country	:	US
Telephone Number	:	404-367-3014
Fax Number	:

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

Provider Enumeration Date	:	01/20/2020
Last Update Date	:	12/03/2025

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Directions to “ DAT M NGUYEN PA-C” Practice Location

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