Provider Demographics
NPI:1811109267
Name:LIU, LI (OMD)
Entity type:Individual
Prefix:
First Name:LI
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 E PACES FERRY RD NE STE 201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3319
Mailing Address - Country:US
Mailing Address - Phone:404-841-9994
Mailing Address - Fax:404-264-1470
Practice Address - Street 1:455 E PACES FERRY RD NE STE 201
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3319
Practice Address - Country:US
Practice Address - Phone:404-841-9994
Practice Address - Fax:404-264-1470
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA000044171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist