1003808056 NPI number — DR. NANCY Y TRUONG O.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003808056 NPI number — DR. NANCY Y TRUONG O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUONG
Provider First Name:
NANCY
Provider Middle Name:
Y
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TA
Provider Other First Name:
NANCY
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1003808056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1088 GRASSMEADE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNELLVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30078-5501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-330-9250
Provider Business Mailing Address Fax Number:
678-212-5622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2570 BLACKMON DR STE 350
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30033-6197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-846-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT002057 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 306019142A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52025961 . This is a "BC&BS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2200336 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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