Healthcare Provider Details

I. General information

NPI: 1598983728
Provider Name (Legal Business Name): YONG JIAN LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6244 CROOKED CREEK RD STE B
PEACHTREE CORNERS GA
30092-6137
US

IV. Provider business mailing address

6244 CROOKED CREEK RD STE B
PEACHTREE CORNERS GA
30092-6137
US

V. Phone/Fax

Practice location:
  • Phone: 770-242-0889
  • Fax: 678-714-6918
Mailing address:
  • Phone: 770-242-0889
  • Fax: 678-714-6918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number052409
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: