MEDICARE: CHAMBLEE FAMILY MEDICAL CLINIC LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1821709262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMBLEE FAMILY MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	4897 BUFORD HWY STE 167
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-3670
Country	:	US
Telephone Number	:	770-872-8141
Fax Number	:	770-872-8142

Provider Business Practice Location Address
First Line	:	4897 BUFORD HWY STE 167
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-3670
Country	:	US
Telephone Number	:	770-872-8141
Fax Number	:	770-872-8142

Authorized Official
Title or Position	:	DNP
Name	:	VINCENT CHI NGUYEN
Credential	:	DNP
Telephone Number	:	770-872-8141

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	06/04/2026

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