Provider Demographics
NPI:1275755209
Name:NGUYEN, CUONG DUY (MD)
Entity Type:Individual
Prefix:DR
First Name:CUONG
Middle Name:DUY
Last Name:NGUYEN
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 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:1075 JESSE JEWELL PKWY NE
Practice Address - Street 2:STE B
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3814
Practice Address - Country:US
Practice Address - Phone:770-536-5733
Practice Address - Fax:770-534-2114
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061133208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA468535804AMedicaid
GA468535804AMedicaid