Active NPI
Min Jie Tan, MD
- Internal Medicine Physician
- Lilburn, GA
National Provider Identifier
1033168919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 041492
- Practice address
- 455 Beaver Ruin Rd NW
Lilburn, GA 30047-3413 - Phone
- (770) 923-7778
- Fax
- (770) 923-0180
- NPI assigned
- May 9, 2006
- Last updated
- Apr 18, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 041492 | GA | Primary |
Addresses
Primary practice location
455 Beaver Ruin Rd NW
Lilburn, GA 30047-3413
Mailing address
475 Philip Blvd
Ste 100
Lawrenceville, GA 30046
Phone (770) 995-3300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041492 | GA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gwinnett Clinic LTD | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397779200000",
"number": "1033168919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 PHILIP BLVD",
"address_2": "STE 100",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "30046",
"telephone_number": "770-995-3300",
"fax_number": "770-995-3307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 BEAVER RUIN RD NW",
"city": "LILBURN",
"state": "GA",
"postal_code": "300473413",
"telephone_number": "770-923-7778",
"fax_number": "770-923-0180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "MIN JIE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-09",
"last_updated": "2014-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "041492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lilburn, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.