Healthcare Provider Details

I. General information

NPI: 1073574307
Provider Name (Legal Business Name): HONG LI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3576 SHALLOWFORD RD NE SUITE A
CHAMBLEE GA
30341-2998
US

IV. Provider business mailing address

217 SOUTHERN HILL DR
DULUTH GA
30097-2062
US

V. Phone/Fax

Practice location:
  • Phone: 770-451-9940
  • Fax: 770-451-6996
Mailing address:
  • Phone: 770-495-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number045086
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: