MEDICARE: MS. LI DU LICENSE ACUPUNCTURIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	000042	GA

General Provider Information

NPI Number	:	1467677062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LI DU LICENSE ACUPUNCTURIS

Provider Business Mailing Address
First Line	:	5775 PEACHTREE DUNWOODY RD NE
Second Line	:	C-200
City	:	ATLANTA
State	:	GA
Zip	:	30342-1556
Country	:	US
Telephone Number	:	404-368-6196
Fax Number	:	404-256-2795

Provider Business Practice Location Address
First Line	:	5775 PEACHTREE DUNWOODY RD NE
Second Line	:	C-200
City	:	ATLANTA
State	:	GA
Zip	:	30342-1556
Country	:	US
Telephone Number	:	404-368-6196
Fax Number	:	404-256-2795

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	01/05/2011

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