Provider Demographics
NPI:1457458085
Name:VU, JOHN N (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:VU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:290 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9069
Mailing Address - Country:US
Mailing Address - Phone:770-302-6780
Mailing Address - Fax:678-782-3776
Practice Address - Street 1:80 VININGS DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5994
Practice Address - Country:US
Practice Address - Phone:770-302-6780
Practice Address - Fax:678-782-3776
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2016-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA040813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA272299248OtherTAX ID
GA000699509HMedicaid
GA582395078OtherTAX IDENTIFICATION NUMBER
GA08BDQFRMedicare ID - Type Unspecified
GA000699509HMedicaid