Provider Demographics
NPI:1609049238
Name:NGUYEN, HANH (OD)
Entity type:Individual
Prefix:DR
First Name:HANH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 LAKE HEARN DR NE STE 150
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1445
Mailing Address - Country:US
Mailing Address - Phone:770-951-1897
Mailing Address - Fax:404-459-0475
Practice Address - Street 1:1200 LAKE HEARN DR NE STE 150
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-1445
Practice Address - Country:US
Practice Address - Phone:770-951-1897
Practice Address - Fax:404-459-0475
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA715540924AMedicaid
GA715540924AMedicaid
GAV06982Medicare UPIN