Provider Demographics
NPI:1225420938
Name:VU, NGUYEN NGOC THI (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:NGUYEN
Middle Name:NGOC THI
Last Name:VU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5170
Mailing Address - Country:US
Mailing Address - Phone:770-389-3855
Mailing Address - Fax:770-474-8078
Practice Address - Street 1:1880 HOWARD AVE STE 202
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2611
Practice Address - Country:US
Practice Address - Phone:703-383-4836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007520363AM0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program