Provider Demographics
NPI:1184658031
Name:QUACH, THIEN (STEVEN) D (MD)
Entity Type:Individual
Prefix:
First Name:THIEN (STEVEN)
Middle Name:D
Last Name:QUACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-1006
Mailing Address - Country:US
Mailing Address - Phone:770-948-6824
Mailing Address - Fax:
Practice Address - Street 1:2270 OAK ROAD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2355
Practice Address - Country:US
Practice Address - Phone:404-831-2786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054822208VP0000X
GA54822207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA05BDKHFMedicare ID - Type Unspecified
GAH69611Medicare UPIN