Individual
LAM TRONG PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
677 CHURCH ST NE, MARIETTA, GA 30060-1101
(770) 794-0477
(770) 794-3108
Mailing address
3120 SWALLOW DR NE, MARIETTA, GA 30066-3001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002176
GA
Other
Enumeration date
05/24/2006
Last updated
08/28/2019
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