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General NPI Number Information
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NPI Number | 1245716505
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Entity Type | Individual
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Provider Name | KASEY LILA LIEU FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 3020 CENTERVILLE HWY
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City | SNELLVILLE
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State | GA
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Zip | 30039-4614
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Country | US
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Telephone | 770-978-1331
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Fax | 770-978-8580
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Provider Business Mailing Address
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Address Line | 3020 CENTERVILLE HWY
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City | SNELLVILLE
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State | GA
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Zip | 30039-4614
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Country | US
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Telephone | 770-978-1331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN260530
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License Number State | GA
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