Provider Demographics
NPI:1417682642
Name:NGUYEN, LONG THANH (PA)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 WELLWICK DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2515
Mailing Address - Country:US
Mailing Address - Phone:901-337-0991
Mailing Address - Fax:
Practice Address - Street 1:3615 WELLWICK DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-2515
Practice Address - Country:US
Practice Address - Phone:901-337-0991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant