Provider Demographics
NPI:1073574307
Name:LI, HONG (MD)
Entity Type:Individual
Prefix:
First Name:HONG
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SOUTHERN HILL DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2062
Mailing Address - Country:US
Mailing Address - Phone:770-495-7071
Mailing Address - Fax:
Practice Address - Street 1:3576 SHALLOWFORD RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2998
Practice Address - Country:US
Practice Address - Phone:770-451-9940
Practice Address - Fax:770-451-6996
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00836569BMedicaid
GA890754OtherONE HEALTH PLAN
GA0101639OtherUNITED HEALTHCARE
GA52782938002OtherBCBS
GA796101OtherCIGNA HMO
GAG98397Medicare UPIN
GA890754OtherONE HEALTH PLAN