Nicolas Thong Pham, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

97811 Issued in GA

Practice address

115 Lee Byrd Rd
Loganville, GA 30052-2310

Phone

(770) 554-4717

Fax

(770) 554-4681

NPI assigned

Aug 24, 2020

Last updated

Dec 18, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gwinnett Physician Group, LLCGroup PAC ID 9133211139, 112 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Amedisys Home Health of Covington Home health agency, Covington, GA, CCN 117065
• Piedmont Eastside Medical Center Hospital, Snellville, GA, CCN 110192
• Piedmont Walton Hospital Hospital, Monroe, GA, CCN 110046
• Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Gwinnett Physician Group, LLC

  • Internal Medicine Physician
  • Lawrenceville, GA
  • NPI 1578574661
  Medicare reassignment Care Compare group NPD
• Gwinnett Medical Group, Inc

  • General Practice Physician
  • Lawrenceville, GA
  • NPI 1780747469

  Internal Medicine

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Amedisys Georgia, L.L.C.

  dba Amedisys Home Health of Covington

  • Home Health Agency
  • Covington, GA
  • NPI 1134177835
  Care Compare affiliation
• Eastside Medical Center, LLC

  dba Piedmont Eastside Medical Center

  • General Acute Care Hospital
  • Snellville, GA
  • NPI 1467406132
  Care Compare affiliation
• Northside Hospital, Inc.

  dba Northside Hospital Gwinnett

  • General Acute Care Hospital
  • Lawrenceville, GA
  • NPI 1952340994
  Care Compare affiliation
• Piedmont Walton Hospital Inc

  • General Acute Care Hospital
  • Monroe, GA
  • NPI 1720589328
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1083226708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 LEE BYRD RD",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522310",
            "telephone_number": "770-554-4717",
            "fax_number": "770-554-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 LEE BYRD RD",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522310",
            "telephone_number": "770-554-4717",
            "fax_number": "770-554-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "NICOLAS",
        "middle_name": "THONG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-24",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "97811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Love Perkins, D.C.
• Personal Care EMS LLC
• Susan M Perz, LMFT
• Richard George Petty, M.D.
• Tammy Petty, P.T.
• Jayson B. Phelps, DPM
• Physiotherapy Associates Inc (Physio-Loganville)
• Piedmont Healthcare Encompass Health Eastside Rehab Hospital, LLC (Eastside Rehabilitation Hospital)
• Kenneth Pierce, CADC II
• Amanda G Pilz, MPT

• Internal Medicine Physician in Loganville, GA
• Providers in Loganville, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.