Provider Demographics
NPI:1144294505
Name:NGUYEN, THANG (DO)
Entity type:Individual
Prefix:DR
First Name:THANG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3985 STEVE REYNOLDS BLVD
Mailing Address - Street 2:SUITE K-102
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3035
Mailing Address - Country:US
Mailing Address - Phone:678-367-0390
Mailing Address - Fax:678-245-3391
Practice Address - Street 1:3985 STEVE REYNOLDS BLVD
Practice Address - Street 2:SUITE K-102
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3035
Practice Address - Country:US
Practice Address - Phone:678-367-0390
Practice Address - Fax:678-245-3391
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG57408Medicare UPIN