Healthcare Provider Details

I. General information

NPI: 1083455570
Provider Name (Legal Business Name): LIANG HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-2901
US

IV. Provider business mailing address

1120 15TH ST # BA-2723
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2020
  • Fax:
Mailing address:
  • Phone: 762-375-0695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number3015685
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: