Healthcare Provider Details

I. General information

NPI: 1811109267
Provider Name (Legal Business Name): LI LIU OMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E PACES FERRY RD NE STE 201
ATLANTA GA
30305-3319
US

IV. Provider business mailing address

455 E PACES FERRY RD NE STE 201
ATLANTA GA
30305-3319
US

V. Phone/Fax

Practice location:
  • Phone: 404-841-9994
  • Fax: 404-264-1470
Mailing address:
  • Phone: 404-841-9994
  • Fax: 404-264-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000044
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: