Provider Demographics
NPI:1538801394
Name:TRAN, QUANG HUY VU
Entity type:Individual
Prefix:
First Name:QUANG HUY
Middle Name:VU
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 HALLETTS PEAK PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-0105
Mailing Address - Country:US
Mailing Address - Phone:404-723-3471
Mailing Address - Fax:
Practice Address - Street 1:605 BEAVER RUIN RD NW STE C
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3430
Practice Address - Country:US
Practice Address - Phone:573-821-0352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10972363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10972OtherPHYSICIAN ASSISTANT STATE LICENSE