MEDICARE: TRUC MY THI DAO 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	13764	GA

General Provider Information

NPI Number	:	1619821394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRUC MY THI DAO PA-C

Provider Business Mailing Address
First Line	:	2615 E WEST CONNECTOR STE 106
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-6854
Country	:	US
Telephone Number	:	770-941-0010
Fax Number	:	770-941-0154

Provider Business Practice Location Address
First Line	:	2615 E WEST CONNECTOR STE 106
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-6854
Country	:	US
Telephone Number	:	770-941-0010
Fax Number	:	770-941-0154

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

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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Directions to “ TRUC MY THI DAO PA-C” Practice Location

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