Provider Demographics
NPI:1942805759
Name:NGUYEN, HOANG MAI THI (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOANG MAI
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 GREENWICH ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1609
Mailing Address - Country:US
Mailing Address - Phone:404-723-3199
Mailing Address - Fax:
Practice Address - Street 1:485 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-3226
Practice Address - Country:US
Practice Address - Phone:770-444-0182
Practice Address - Fax:770-437-0649
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist