=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972884815
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA C LIU LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2011
-----------------------------------------------------
Last Update Date | 09/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11379 S BRIDGE PKWY
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30022-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-289-2305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2725 NIBLICK WAY
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30097-8183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-289-2305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 277
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174V00000X
-----------------------------------------------------
Taxonomy Name | Clinical Ethicist
-----------------------------------------------------
License Number | 277
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------