Basic Information
| Provider Information | |||||||||
| NPI: | 1528510146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | HONG | ||||||||
| MiddleName: | DIEM | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 716 SUHOLDEN CIR | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300663760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706016308 | ||||||||
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| Practice Location | |||||||||
| Address1: | 191 LAMAR HALEY PKWY | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301148019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707041600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2016 | ||||||||
| LastUpdateDate: | 10/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN228970 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.