Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 053628 | GA |
N | 208600000X | Surgeon | 053628 | GA |
Y | 2086S0102X | Surgical Critical Care | 053628 | GA |
N | 2086S0127X | Trauma Surgeon | 053628 | GA |
NPI | 1407876139 |
---|---|
Provider Name | Uy Quoc Vu |
First Address | Lawrenceville, GA 30046-3370 |
Second Address | Lawrenceville, GA 30046-3367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053628 | MEDICAL LICENSE - ACTIVE (01) | GA |
BV9772802 | FEDERAL DEA (01) |