Healthcare Provider Details

I. General information

NPI: 1861845349
Provider Name (Legal Business Name): LI ZHU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 WINTER ROSE CT
ATLANTA GA
30360-6003
US

IV. Provider business mailing address

2827 WINTER ROSE CT
ATLANTA GA
30360-6003
US

V. Phone/Fax

Practice location:
  • Phone: 678-978-3068
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number108
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: