Provider Demographics
NPI:1518348044
Name:DUAN, AZURE (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:AZURE
Middle Name:
Last Name:DUAN
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 OLD NORCROSS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8804
Mailing Address - Country:US
Mailing Address - Phone:770-310-8070
Mailing Address - Fax:
Practice Address - Street 1:1838 OLD NORCROSS RD STE 300
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8804
Practice Address - Country:US
Practice Address - Phone:770-310-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000362171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist