Provider Demographics
NPI:1770691818
Name:NGUYEN, CHRISTINA NGOC (MD)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:NGOC
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:4754 MARTIN RD
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3507
Practice Address - Country:US
Practice Address - Phone:770-965-0847
Practice Address - Fax:770-965-0974
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL26916207Q00000X
GA059083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA517890194AMedicaid
GA517890194AMedicaid
GA08CBCPQMedicare PIN
SC26702Medicare UPIN