Healthcare Provider Details

I. General information

NPI: 1518195601
Provider Name (Legal Business Name): LEI LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4904 TIMBER RIDGE DR STE 104
DOUGLASVILLE GA
30135-1831
US

IV. Provider business mailing address

4904 TIMBER RIDGE DR STE 104
DOUGLASVILLE GA
30135-1831
US

V. Phone/Fax

Practice location:
  • Phone: 770-942-4822
  • Fax:
Mailing address:
  • Phone: 770-942-4822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberFL44448608
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.34462
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101279532
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number97805
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: