Provider Demographics
NPI:1164066122
Name:TRAN MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:TRAN MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRUNG
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-277-7202
Mailing Address - Street 1:605 BEAVER RUIN RD NW STE C
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3430
Mailing Address - Country:US
Mailing Address - Phone:770-277-7202
Mailing Address - Fax:
Practice Address - Street 1:605 BEAVER RUIN RD NW STE C
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3430
Practice Address - Country:US
Practice Address - Phone:770-277-7202
Practice Address - Fax:770-277-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-03
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center