Provider Demographics
NPI:1215196522
Name:TUAN MINH-QUOC NGUYEN, LLC
Entity Type:Organization
Organization Name:TUAN MINH-QUOC NGUYEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-454-9047
Mailing Address - Street 1:4720 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1547
Mailing Address - Country:US
Mailing Address - Phone:770-454-9047
Mailing Address - Fax:770-457-6311
Practice Address - Street 1:4720 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 202A
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1547
Practice Address - Country:US
Practice Address - Phone:770-454-9047
Practice Address - Fax:770-457-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA303268OtherWELLCARE
GA85002012GOtherGEORGIA BETTER HEALTH CARE
GA00747832AMedicaid
GA10033241OtherAMERIGROUP
GA000747832AOtherPEACH STATE
GA11BDRDTMedicare UPIN