Provider Demographics
NPI:1184206922
Name:NGUYEN, TONY
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 WATERCOURSE WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8470
Mailing Address - Country:US
Mailing Address - Phone:404-907-9944
Mailing Address - Fax:
Practice Address - Street 1:762 WATERCOURSE WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8470
Practice Address - Country:US
Practice Address - Phone:404-907-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No291U00000XLaboratoriesClinical Medical Laboratory
No174200000XOther Service ProvidersMealsGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore Provider
No1744R1102XOther Service ProvidersSpecialistResearch Study