Provider Demographics
NPI:1558347427
Name:LUU, QUYEN NGOC (MD)
Entity Type:Individual
Prefix:
First Name:QUYEN
Middle Name:NGOC
Last Name:LUU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:458 HEMLOCK ST
Mailing Address - Street 2:STE 200
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-4200
Mailing Address - Country:US
Mailing Address - Phone:478-741-5945
Mailing Address - Fax:478-743-5890
Practice Address - Street 1:458 HEMLOCK ST
Practice Address - Street 2:STE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-4200
Practice Address - Country:US
Practice Address - Phone:478-741-5945
Practice Address - Fax:478-743-5890
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA025216207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000307447BMedicaid
D30104Medicare UPIN
GA000307447BMedicaid