Provider Demographics
NPI:1164906533
Name:NGUYEN, THUHAU THI
Entity Type:Individual
Prefix:
First Name:THUHAU
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 FELLOWSHIP RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4609
Mailing Address - Country:US
Mailing Address - Phone:167-893-6662
Mailing Address - Fax:
Practice Address - Street 1:2212 FELLOWSHIP RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4609
Practice Address - Country:US
Practice Address - Phone:678-936-6625
Practice Address - Fax:678-580-2023
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-1729251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health