Provider Demographics
NPI:1073825501
Name:NGUYEN, TRANG MAI (NP)
Entity Type:Individual
Prefix:
First Name:TRANG
Middle Name:MAI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 J L WHITE DR
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4908
Mailing Address - Country:US
Mailing Address - Phone:706-299-2220
Mailing Address - Fax:
Practice Address - Street 1:1020 J L WHITE DR
Practice Address - Street 2:SUITE 110A
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4908
Practice Address - Country:US
Practice Address - Phone:706-299-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003112810DMedicaid
GA003112810KMedicaid
GA003112810HMedicaid
GA003112810FMedicaid
GARN177230OtherGEORGIA BOARD OF NURSING
GA003112810CMedicaid
GA003112810EMedicaid
GA003112810JMedicaid
GA003112810GMedicaid
GA003112810IMedicaid
GA003112810NMedicaid
GA003112810AMedicaid
GA003112810BMedicaid
GA003112810MMedicaid
GA003112810OMedicaid
GA003112810PMedicaid
GA003112810QMedicaid
GA003112810LMedicaid