Healthcare Provider Details

I. General information

NPI: 1346931375
Provider Name (Legal Business Name): CHAO LI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 HOUZE RD STE 225
ROSWELL GA
30076-5618
US

IV. Provider business mailing address

11111 HOUZE RD STE 225
ROSWELL GA
30076-5618
US

V. Phone/Fax

Practice location:
  • Phone: 770-603-0123
  • Fax: 770-910-9919
Mailing address:
  • Phone: 770-603-0123
  • Fax: 770-910-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4001244
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP001654
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: