Provider Demographics
NPI:1043247349
Name:NGO, THUY T (MD)
Entity type:Individual
Prefix:DR
First Name:THUY
Middle Name:T
Last Name:NGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THUY
Other - Middle Name:T
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:315 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2603
Mailing Address - Country:US
Mailing Address - Phone:931-528-5633
Mailing Address - Fax:931-528-5798
Practice Address - Street 1:315 N WASHINGTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2660
Practice Address - Country:US
Practice Address - Phone:931-528-5633
Practice Address - Fax:931-528-5798
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25547174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN101OtherJOHN DEERE
TN3086391Medicaid
TN080187007OtherRAILROAD MEDICARE
TN4037809OtherBLUE CROSS
TN481263448OtherTAX ID
TN481263448OtherTAX ID
TNTN101OtherJOHN DEERE