Provider Demographics
NPI:1124286687
Name:FU, LIUSONG JASON (MD)
Entity type:Individual
Prefix:DR
First Name:LIUSONG
Middle Name:JASON
Last Name:FU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:58 TIMBER CREEK DR
Mailing Address - Street 2:HEALTHQUEST
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4233
Mailing Address - Country:US
Mailing Address - Phone:901-566-1002
Mailing Address - Fax:901-566-1951
Practice Address - Street 1:8130 COUNTRY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2087
Practice Address - Country:US
Practice Address - Phone:901-308-2915
Practice Address - Fax:901-308-2924
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2020-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN469902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04256723Medicaid
TN1527911Medicaid