Provider Demographics
NPI:1659369593
Name:LIU, JOE C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:C
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 BUFORD HWY
Mailing Address - Street 2:STE C-200
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1153
Mailing Address - Country:US
Mailing Address - Phone:770-454-9199
Mailing Address - Fax:770-458-1388
Practice Address - Street 1:5150 BUFORD HWY
Practice Address - Street 2:STE C-200
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1153
Practice Address - Country:US
Practice Address - Phone:770-454-9199
Practice Address - Fax:770-458-1388
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17403170100000X
GA017403208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00069275AMedicaid