MEDICARE: THANH NGUYEN 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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	16168	GA
2	207P00000X	Emergency Medicine Physician	16168	GA

General Provider Information

NPI Number	:	1780263343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THANH NGUYEN MD

Provider Business Mailing Address
First Line	:	641 NORTH AVE NE APT 3126
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-3070
Country	:	US
Telephone Number	:	281-515-3315
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 NORTH AVE NE APT 3126
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-3070
Country	:	US
Telephone Number	:	281-515-3315
Fax Number	:

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

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	04/18/2025

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