Healthcare Provider Details

I. General information

NPI: 1023225190
Provider Name (Legal Business Name): LI ZUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 PLEASANT HILL RD SUITE 200
DULUTH GA
30096-5142
US

IV. Provider business mailing address

3500 DULUTH PARK LN STE 820
DULUTH GA
30096-3243
US

V. Phone/Fax

Practice location:
  • Phone: 678-837-5224
  • Fax: 404-860-1298
Mailing address:
  • Phone: 678-837-5224
  • Fax: 404-860-1298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number75964
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number75964
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: