Provider Demographics
NPI:1528510146
Name:NGUYEN, HONG DIEM (NP-C)
Entity type:Individual
Prefix:
First Name:HONG
Middle Name:DIEM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 SUHOLDEN CIR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3760
Mailing Address - Country:US
Mailing Address - Phone:770-601-6308
Mailing Address - Fax:
Practice Address - Street 1:191 LAMAR HALEY PKWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8019
Practice Address - Country:US
Practice Address - Phone:770-704-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN228970363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner