Lavista Primary Care | |
4865 Lavista Rd Tucker GA 30084-4436 | |
(770) 270-0290 | |
Not Available |
Full Name | Lavista Primary Care |
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Speciality | General Practice |
Location | 4865 Lavista Rd, Tucker, Georgia |
Authorized Official Name and Position | Lien D. Nguyen (PRESIDENT) |
Authorized Official Contact | 7702700290 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Lavista Primary Care Po Box 29528 Atlanta GA 30359-0528 Ph: () - | Lavista Primary Care 4865 Lavista Rd Tucker GA 30084-4436 Ph: (770) 270-0290 |
NPI Number | 1679614465 |
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Provider Enumeration Date | 02/12/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679614465 | NPI | - | NPPES |
00614116C | Medicaid | GA | |
1154358760 | Other | GA | DICH VAN NGUYEN, MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | 036656 (Georgia) | Primary |
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N.d. Lien, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4865 Lavista Rd, Suite A, Tucker, GA 30084 Phone: 770-270-0290 Fax: 770-723-0598 | |
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