Provider Demographics
NPI:1134198765
Name:TU, CHANH M (MD)
Entity type:Individual
Prefix:
First Name:CHANH
Middle Name:M
Last Name:TU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1119 E LAMAR ST
Mailing Address - Street 2:P O BOX 788
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3762
Mailing Address - Country:US
Mailing Address - Phone:229-924-4022
Mailing Address - Fax:229-924-7133
Practice Address - Street 1:1119 E LAMAR ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3762
Practice Address - Country:US
Practice Address - Phone:229-924-4022
Practice Address - Fax:229-924-7133
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA042468207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000720178EMedicaid
GA00720178AMedicaid
GA000720178DMedicaid
GA0404680001Medicare NSC
GA180031480Medicare PIN
GA00720178AMedicaid
GA18BDDZMMedicare PIN