Provider Demographics
NPI:1255869970
Name:LE, THUY
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 CLINIC AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4454
Mailing Address - Country:US
Mailing Address - Phone:770-832-0429
Mailing Address - Fax:
Practice Address - Street 1:395 W 27TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3018
Practice Address - Country:US
Practice Address - Phone:910-739-7551
Practice Address - Fax:910-739-2332
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92541207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology