Provider Demographics
NPI:1710066790
Name:PHAM, NGAN MAI (MD)
Entity Type:Individual
Prefix:DR
First Name:NGAN
Middle Name:MAI
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6080 LAKEVIEW RD
Mailing Address - Street 2:APT.1801
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8593
Mailing Address - Country:US
Mailing Address - Phone:713-301-3030
Mailing Address - Fax:
Practice Address - Street 1:145 TECHNOLOGY PKWY
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2913
Practice Address - Country:US
Practice Address - Phone:800-780-3500
Practice Address - Fax:770-246-0882
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 90339207L00000X
GA58382207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology