Provider Demographics
NPI:1730558735
Name:DULUTH FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:DULUTH FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIEM
Authorized Official - Middle Name:CHI
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-858-5983
Mailing Address - Street 1:4470 SATELLITE BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8851
Mailing Address - Country:US
Mailing Address - Phone:770-858-5983
Mailing Address - Fax:770-858-5066
Practice Address - Street 1:4470 SATELLITE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8851
Practice Address - Country:US
Practice Address - Phone:770-858-5983
Practice Address - Fax:770-858-5066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-20
Last Update Date:2015-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty