Provider Demographics
NPI:1922416080
Name:NGUYEN, BAO TRAM THI (DO)
Entity Type:Individual
Prefix:DR
First Name:BAO TRAM
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 STONEY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2896
Mailing Address - Country:US
Mailing Address - Phone:678-617-4033
Mailing Address - Fax:
Practice Address - Street 1:2685 PEACHTREE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1048
Practice Address - Country:US
Practice Address - Phone:770-771-5260
Practice Address - Fax:770-771-5279
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004760A208D00000X
GA89158207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice