MEDICARE: CLARKSTON FAMILY MEDICINE

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	305S00000X	Point of Service	019886	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588944771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARKSTON FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	3603 W HILL ST
Second Line	:
City	:	CLARKSTON
State	:	GA
Zip	:	30021-1207
Country	:	US
Telephone Number	:	404-299-7534
Fax Number	:	404-299-0608

Provider Business Practice Location Address
First Line	:	3603 W HILL ST
Second Line	:
City	:	CLARKSTON
State	:	GA
Zip	:	30021-1207
Country	:	US
Telephone Number	:	404-299-7534
Fax Number	:	404-299-0608

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. MINBH THO HUYNH
Credential	:	M.D.
Telephone Number	:	404-299-7534

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	08/19/2011

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Directions to “CLARKSTON FAMILY MEDICINE ” Practice Location

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