Provider Demographics
NPI:1922430214
Name:NGUYEN, TAM BAO (MD MSHP DIPABLM)
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:BAO
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD MSHP DIPABLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 ABUTMENT RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-4887
Mailing Address - Country:US
Mailing Address - Phone:706-598-6700
Mailing Address - Fax:
Practice Address - Street 1:11445 COMPAQ CENTER WEST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1433
Practice Address - Country:US
Practice Address - Phone:281-251-3049
Practice Address - Fax:281-251-4095
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA757392083P0901X
TXS02002083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine