Provider Demographics
NPI:1164536843
Name:THAI, PHU B (MD)
Entity Type:Individual
Prefix:DR
First Name:PHU
Middle Name:B
Last Name:THAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PHU
Other - Middle Name:B
Other - Last Name:THAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3495 PIEDMONT ROAD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-949-5019
Mailing Address - Fax:404-364-4985
Practice Address - Street 1:3650 STEVE REYNOLDS BLVD
Practice Address - Street 2:GWINNETT MEDICAL CENTER DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-931-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00026954207R00000X
GA059519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I64401Medicare UPIN