Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | 17403 | GA |
Y | 208000000X | Pediatrician | 017403 | GA |
NPI | 1659369593 |
---|---|
Provider Name | Dr. Joe C Liu |
First Address | Doraville, GA 30340-1153 |
Second Address | Doraville, GA 30340-1153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 17/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00069275A | (05) | GA |