Provider Demographics
NPI:1457943565
Name:PHAN, HUU (PA-C)
Entity Type:Individual
Prefix:MR
First Name:HUU
Middle Name:
Last Name:PHAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:HUU
Other - Middle Name:
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HUU PHAN, PA-C
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE STE 1700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3087
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:6300 HOSPITAL PKWY STE 400
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1983
Practice Address - Country:US
Practice Address - Phone:678-205-4261
Practice Address - Fax:678-417-7187
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty