Provider Demographics
NPI:1144218082
Name:HUYNH, MINH-THO (MD)
Entity Type:Individual
Prefix:DR
First Name:MINH-THO
Middle Name:
Last Name:HUYNH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 W HILL ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-1207
Mailing Address - Country:US
Mailing Address - Phone:404-299-7534
Mailing Address - Fax:404-299-0608
Practice Address - Street 1:3603 W HILL ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-1207
Practice Address - Country:US
Practice Address - Phone:404-299-7534
Practice Address - Fax:404-299-0608
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000226003CMedicaid
G63652Medicare UPIN