Individual
THAO NGOC NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
777 HEMLOCK ST, MACON, GA 31201-2102
(478) 633-1007
Mailing address
777 HEMLOCK ST, MACON, GA 31201-2102
(478) 633-1007
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6409
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003123746E
—
GA
05
—
003123746G
—
GA
01
—
P01312477
RAILROAD MEDICARE
GA
Enumeration date
04/25/2012
Last updated
10/06/2016
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