Provider Demographics
NPI:1710582374
Name:NGO, NHAN QUANG
Entity Type:Individual
Prefix:
First Name:NHAN
Middle Name:QUANG
Last Name:NGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 SUMMER STREAM LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-5881
Mailing Address - Country:US
Mailing Address - Phone:678-790-9905
Mailing Address - Fax:
Practice Address - Street 1:2795 CHASTAIN MEADOWS PKWY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3361
Practice Address - Country:US
Practice Address - Phone:770-427-2480
Practice Address - Fax:770-427-7661
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist