Provider Demographics
NPI:1972884815
Name:LIU, ANGELA C (LAC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:C
Last Name:LIU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 NIBLICK WAY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8183
Mailing Address - Country:US
Mailing Address - Phone:770-289-2305
Mailing Address - Fax:
Practice Address - Street 1:11379 S BRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4402
Practice Address - Country:US
Practice Address - Phone:770-289-2305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA277171100000X, 174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174V00000XOther Service ProvidersClinical Ethicist