Basic Information
Provider Information
NPI: 1730176009
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRINH
FirstName: LOUIS
MiddleName: D.
NamePrefix:  
NameSuffix:  
Credential: PAAA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3155 N POINT PKWY
Address2: ATTN: CREDENTIALING DEPT, BUILDING F, SUITE 100
City: ALPHARETTA
State: GA
PostalCode: 30005
CountryCode: US
TelephoneNumber: 7706459181
FaxNumber: 7706458455
Practice Location
Address1: 1000 JOHNSON FERRY RD NE
Address2:  
City: ATLANTA
State: GA
PostalCode: 303421606
CountryCode: US
TelephoneNumber: 7706459181
FaxNumber: 7706458455
Other Information
ProviderEnumerationDate: 10/03/2005
LastUpdateDate: 02/04/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367H00000X3006GAY Physician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant 

No ID Information.


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