Provider Demographics
NPI:1528209715
Name:NGUYEN, THINH DUC (MD)
Entity Type:Individual
Prefix:
First Name:THINH
Middle Name:DUC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 HOWELL MILL RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2512
Mailing Address - Country:US
Mailing Address - Phone:678-515-0688
Mailing Address - Fax:404-829-2380
Practice Address - Street 1:1891 HOWELL MILL RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2512
Practice Address - Country:US
Practice Address - Phone:678-515-0688
Practice Address - Fax:404-829-2380
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062402207Q00000X, 207Q00000X
MI5315039580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I086003OtherMEDICARE INDIVIDUAL PTAN
GA202G7018483OtherMEDICARE GROUP PTAN
GA202I081480Medicare PIN