Provider Demographics
NPI:1629463500
Name:NGO, QUOC VINH (MD)
Entity Type:Individual
Prefix:
First Name:QUOC
Middle Name:VINH
Last Name:NGO
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:WELLSTAR WEST GEORGIA MEDICAL CENTER
Mailing Address - Street 2:1504 VERNON ROAD
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240
Mailing Address - Country:US
Mailing Address - Phone:706-882-1411
Mailing Address - Fax:
Practice Address - Street 1:WELLSTAR WEST GEORGIA MEDICAL CENTER
Practice Address - Street 2:1504 VERNON ROAD
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240
Practice Address - Country:US
Practice Address - Phone:706-884-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80387207PE0004X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services