Doctor Name: | MISS NGUYEN NGOC THI VU |
NPI Number: | 1225420938 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | |
Business Practice Address: | 1287 Spur 138 Jonesboro, GA - 302362419 |
Business Phone Number: | 7704719990 |
Business Fax Number: | |
Mailing Address: | 1324 Highway 138 Sw, RIVERDALE |
State: | GA |
Postal Code: | 302961404 |
Phone Number: | 7709074949 |
Fax Number: | 7709074022 |
NPI Enumeration Date: | 03/04/2015 |
NPI Last Update Date: | 09/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |