Healthcare Provider Details

I. General information

NPI: 1427419621
Provider Name (Legal Business Name): LILIAN HA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ARCADIA AVE
DECATUR GA
30030-2115
US

IV. Provider business mailing address

2162 MURRY TRL
MORROW GA
30260-1388
US

V. Phone/Fax

Practice location:
  • Phone: 404-297-1540
  • Fax:
Mailing address:
  • Phone: 404-964-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN015324
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: