Provider Demographics
NPI:1407204266
Name:NGUYEN, VINCENT CHI
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:CHI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3496 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3021
Mailing Address - Country:US
Mailing Address - Phone:770-248-9345
Mailing Address - Fax:770-797-9615
Practice Address - Street 1:3496 CLUB DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3021
Practice Address - Country:US
Practice Address - Phone:770-248-9345
Practice Address - Fax:770-797-9615
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN288457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily