Provider Demographics
NPI:1285834903
Name:NGUYEN, NGOC THUY LE (LIC ACU-DOM)
Entity Type:Individual
Prefix:MS
First Name:NGOC
Middle Name:THUY LE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LIC ACU-DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5888 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-1103
Mailing Address - Country:US
Mailing Address - Phone:770-961-1011
Mailing Address - Fax:770-961-1011
Practice Address - Street 1:5888 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1103
Practice Address - Country:US
Practice Address - Phone:770-961-1011
Practice Address - Fax:770-961-1011
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000074171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist