1609819283 NPI number — DR. CECILE Q. NGUYEN MD

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 1609819283 NPI number — DR. CECILE Q. NGUYEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
CECILE
Provider Middle Name:
Q.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOLUTIONS
Provider Other First Name:
GEORGIA
Provider Other Middle Name:
HEALTHIER
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609819283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 229
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRIFFIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30224-0006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-766-4633
Provider Business Mailing Address Fax Number:
404-766-1108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1029 CLEVELAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-766-4633
Provider Business Practice Location Address Fax Number:
404-766-1108
Provider Enumeration Date:
06/13/2006

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: 207RG0300X , with the licence number:  039644 , 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: 00735622C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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