Provider Demographics
NPI:1861856387
Name:NGUYEN, THU HA (MD)
Entity Type:Individual
Prefix:
First Name:THU HA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:232 W DEADERICK ST APT 109
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-5978
Mailing Address - Country:US
Mailing Address - Phone:469-767-9175
Mailing Address - Fax:
Practice Address - Street 1:700 W FOREST AVE STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3946
Practice Address - Country:US
Practice Address - Phone:314-220-3107
Practice Address - Fax:731-422-0475
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD63247208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery