Provider Demographics
NPI:1629222344
Name:DONG, HAN NGOC (NP)
Entity Type:Individual
Prefix:
First Name:HAN
Middle Name:NGOC
Last Name:DONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6236 GRACELAND CIR
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-1616
Mailing Address - Country:US
Mailing Address - Phone:770-961-4344
Mailing Address - Fax:
Practice Address - Street 1:6236 GRACELAND CIR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1616
Practice Address - Country:US
Practice Address - Phone:770-961-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145895 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily