Healthcare Provider Details

I. General information

NPI: 1669299822
Provider Name (Legal Business Name): JIMEI LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5789 CARRIAGE HILLS DR
AUGUSTA GA
30907-8208
US

IV. Provider business mailing address

5789 CARRIAGE HILLS DR
AUGUSTA GA
30907-8208
US

V. Phone/Fax

Practice location:
  • Phone: 706-589-0729
  • Fax:
Mailing address:
  • Phone: 706-589-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number266932
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: