Provider Demographics
NPI:1578098091
Name:LI, MENG (MD)
Entity Type:Individual
Prefix:
First Name:MENG
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 1:1049 N HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-1505
Mailing Address - Country:US
Mailing Address - Phone:478-922-9001
Mailing Address - Fax:478-329-8619
Practice Address - Street 1:1049 N HOUSTON RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-1505
Practice Address - Country:US
Practice Address - Phone:478-922-9001
Practice Address - Fax:478-329-8619
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2020-12-08
Deactivation Date:2017-11-27
Deactivation Code:
Reactivation Date:2018-01-17
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA84425208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program