Provider Demographics
NPI:1821709262
Name:CHAMBLEE FAMILY MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:CHAMBLEE FAMILY MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP-C
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:CHI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP-C
Authorized Official - Phone:770-872-8141
Mailing Address - Street 1:4897 BUFORD HWY STE 167
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4897 BUFORD HWY STE 167
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3670
Practice Address - Country:US
Practice Address - Phone:770-872-8141
Practice Address - Fax:770-872-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty