Provider Demographics
NPI:1629192026
Name:NGUYEN, KIMBERLY T (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3496 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3021
Mailing Address - Country:US
Mailing Address - Phone:770-248-9345
Mailing Address - Fax:770-797-9615
Practice Address - Street 1:3496 CLUB DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3021
Practice Address - Country:US
Practice Address - Phone:770-248-9345
Practice Address - Fax:770-797-9615
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000908179BMedicaid
GA837002OtherBCBS