Basic Information
Provider Information
NPI: 1033580139
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NGUYEN
FirstName: KAREN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2301 HENRY CLOWER BLVD
Address2: STE. A
City: SNELLVILLE
State: GA
PostalCode: 300783152
CountryCode: US
TelephoneNumber: 7709789393
FaxNumber:  
Practice Location
Address1: 2301 HENRY CLOWER BLVD
Address2:  
City: SNELLVILLE
State: GA
PostalCode: 300783152
CountryCode: US
TelephoneNumber: 7709789393
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/14/2015
LastUpdateDate: 07/27/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X7753GAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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