Provider Demographics
NPI:1255474409
Name:NGUYEN, XAVIER ANH (DO)
Entity Type:Individual
Prefix:
First Name:XAVIER
Middle Name:ANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4897 BUFORD HWY
Mailing Address - Street 2:SUITE 167
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3667
Mailing Address - Country:US
Mailing Address - Phone:770-458-8377
Mailing Address - Fax:770-458-8746
Practice Address - Street 1:4897 BUFORD HWY
Practice Address - Street 2:SUITE 167
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3667
Practice Address - Country:US
Practice Address - Phone:770-458-8377
Practice Address - Fax:770-458-8746
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA044973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00808112AMedicaid
GA304161OtherWELLCARE OF GEORGIA
GA304161OtherWELLCARE OF GEORGIA
GA08BDPJXMedicare ID - Type Unspecified