MEDICARE: DR. PAUL HUYDAO NGUYEN M.D.

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	207R00000X	Internal Medicine Physician	047813	GA

General Provider Information

NPI Number	:	1861486094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL HUYDAO NGUYEN M.D.

Provider Business Mailing Address
First Line	:	5456 JIMMY CARTER BLVD
Second Line	:	SUITE 240
City	:	NORCROSS
State	:	GA
Zip	:	30093-1545
Country	:	US
Telephone Number	:	678-380-9889
Fax Number	:	770-717-5834

Provider Business Practice Location Address
First Line	:	5456 JIMMY CARTER BLVD
Second Line	:	SUITE 240
City	:	NORCROSS
State	:	GA
Zip	:	30093-1511
Country	:	US
Telephone Number	:	678-380-9889
Fax Number	:	770-717-5834

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	09/05/2012

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