Provider Demographics
NPI:1437319993
Name:PHAM, DONALD MINH (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MINH
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1001 SUMMIT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-6410
Mailing Address - Country:US
Mailing Address - Phone:770-989-1634
Mailing Address - Fax:678-358-1759
Practice Address - Street 1:301 PHILIP BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:770-822-5560
Practice Address - Fax:770-822-4989
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA071551207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003146015Medicaid