MEDICARE: DR. LIYUN LIU MD

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	207R00000X	Internal Medicine Physician	95975	GA

General Provider Information

NPI Number	:	1932713658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIYUN LIU MD

Provider Business Mailing Address
First Line	:	730 GLYNN ST S
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-2050
Country	:	US
Telephone Number	:	770-460-3658
Fax Number	:	770-460-3657

Provider Business Practice Location Address
First Line	:	730 GLYNN ST S
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-2050
Country	:	US
Telephone Number	:	770-460-3658
Fax Number	:	770-460-3657

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

Provider Enumeration Date	:	08/31/2020
Last Update Date	:	09/12/2023

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