Provider Demographics
NPI:1598637779
Name:PHAM, MAITRAM THI (BS)
Entity type:Individual
Prefix:
First Name:MAITRAM
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:BS
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Mailing Address - Street 1:1375 STONEGATE LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4421
Mailing Address - Country:US
Mailing Address - Phone:770-680-9967
Mailing Address - Fax:678-840-3574
Practice Address - Street 1:4405 INTERNATIONAL BLVD STE C107
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3019
Practice Address - Country:US
Practice Address - Phone:470-448-4714
Practice Address - Fax:678-840-3574
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPHCP011130253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care