Individual
TAM VIET VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1845 SATELLITE BLVD STE 500, DULUTH, GA 30097-4005
(404) 778-5220
Mailing address
1845 SATELLITE BLVD STE 500, DULUTH, GA 30097-4005
(404) 778-5220
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
100781
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2021
Last updated
09/04/2024
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