NPIMap

Individual provider Active NPI

Amanda Kauffmann Nguyen, M.D.

  • Pediatrics Physician
  • Villa Rica, GA
National Provider Identifier
1073710646
Registry record updated Jan 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
64424 Issued in GA
Practice address
690 Dallas Hwy
Suite 206
Villa Rica, GA 30180-1264
Phone
(770) 456-3265
NPI assigned
Jun 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 64424 GA
Pediatrics Physician 208000000X 64424 GA Primary
Pediatrics Physician 208000000X RTP002369 GA

Addresses

Primary practice location

690 Dallas Hwy
Suite 206
Villa Rica, GA 30180-1264

Mailing address

119 Ambulance Drive
Suite 202
Carrollton, GA 30117
Phone (770) 838-8640

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
64424GAMDPediatrics Physician
RTP002369GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
TMC Children's Healthcare of West Georgia Past Accepting new patients
TMC/Villa Rica Hospital, Inc Past Accepting new patients
Pediatrix Medical Group of Georgia, P.C. Past Accepting new patients
Tanner Medical Group Inc Pediatrics Past Accepting new patients
Pediatrix Medical Group of Georgia, P.C. Past Accepting new patients

Organizations & group practices 5

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": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548201600000",
    "number": "1073710646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 AMBULANCE DRIVE",
            "address_2": "SUITE 202",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "30117",
            "telephone_number": "770-838-8640",
            "fax_number": "770-838-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 DALLAS HWY",
            "address_2": "SUITE 206",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801264",
            "telephone_number": "770-456-3265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "AMANDA",
        "middle_name": "KAUFFMANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-28",
        "last_updated": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "64424",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "64424",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "RTP002369",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Villa Rica, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.