| Lavista Primary Care | |
|
4865 Lavista Rd Tucker GA 30084-4436 | |
| (770) 270-0290 | |
| Not Available |
| Full Name | Lavista Primary Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 4865 Lavista Rd, Tucker, Georgia |
| Authorized Official Name and Position | Lien Duc Nguyen (PRESIDENT) |
| Authorized Official Contact | 7702700290 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lavista Primary Care Po Box 29528 Atlanta GA 30359-0528 Ph: (770) 270-0290 | Lavista Primary Care 4865 Lavista Rd Tucker GA 30084-4436 Ph: (770) 270-0290 |
| NPI Number | 1508900523 |
|---|---|
| Provider Enumeration Date | 02/16/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508900523 | NPI | - | NPPES |
| 00735622C | Medicaid | GA | |
| 1609819283 | Other | GA | DR. CECILE NGUYEN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 039644 (Georgia) | Primary |
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