Thomas A Nguyen, DO
Individual provider Active NPI Family Medicine Physician · East Ellijay, GA
NPI 1669495669 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1669495669
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 062579 (GA)
- Practice address
- 97 Hefner St Ste 202
East Ellijay, GA 30540-8268 - Phone
- (706) 635-5177
- Fax
- (706) 635-5171
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 7
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Michigan State University College of Human Medicine, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ellijay Urgent Care and Family Practice, LLC
Practice addresses (Care Compare)
97 Hefner St
Suite 202
East Ellijay, GA 30540-8268
Phone (706) 635-5177
Hospital & facility affiliations
- Pruitthealth at Home - Gainesville
- Amedisys Northwest Home Health
- Piedmont Mountainside Hospital Inc
- Adventhealth Murray
- Northside Hospital Cherokee
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Ellijay Urgent Care & Family Practice, LLC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Corporate Officer (100%) Corporate Director (100%) W-2 Managing Employee (100%) |
Sep 1, 2017 Sep 1, 2017 Sep 1, 2017 Sep 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090930000083 | GA | Practitioner - Family Practice | 8325033640 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ellijay Urgent Care & Family Practice LLC | Family Medicine | Current |
Accepting new patients |
| Memorial Hospital | Past | Accepting new patients |
Locations
97 Hefner St
Ste 202
East Ellijay, GA 30540
Phone (706) 635-5177
822 Industrial Blvd
Ste C
Ellijay, GA 30540
Phone (706) 635-5177
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 062579 | GA | Yes |
Addresses
Primary practice location
97 Hefner St Ste 202
East Ellijay, GA 30540-8268
Mailing address
97 Hefner St Ste 202
East Ellijay, GA 30540-8268
Phone (706) 635-5177
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52254127 | Other | GA | B/CB/S |
| 006600183A | Medicaid | GA |
Other providers in East Ellijay, GA
- Amanda K Mulherin
- Diamond Mungroo
- Myeyedr Optometry of Georgia, LLC
- New Ground Care LLC
- Tan D. Nguyen
- Shelby Lee Nix
- North Georgia Physical Therapy
- Lesa Parker
- Milton Lynn Perry
- David Romesh Persaud
All providers in East Ellijay, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.