Provider Demographics
NPI:1962495150
Name:TA, LINH T (OD)
Entity type:Individual
Prefix:DR
First Name:LINH
Middle Name:T
Last Name:TA
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:6795 BRAGG RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-4701
Mailing Address - Country:US
Mailing Address - Phone:678-481-8132
Mailing Address - Fax:770-292-9301
Practice Address - Street 1:270 WALMART WAY
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-0824
Practice Address - Country:US
Practice Address - Phone:706-867-9335
Practice Address - Fax:706-867-8679
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2022-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAOPT001539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2200336OtherUNITED HEALTHCARE
GA52637649OtherBC&BS
GA550819396AMedicaid
GA52637649OtherBC&BS
GAU97571Medicare UPIN