Provider Demographics
NPI:1619382561
Name:LI, DAN (NP-C)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HOSPITAL BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4919
Mailing Address - Country:US
Mailing Address - Phone:770-663-4649
Mailing Address - Fax:770-663-3930
Practice Address - Street 1:2500 HOSPITAL BLVD STE 440
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4919
Practice Address - Country:US
Practice Address - Phone:770-663-4649
Practice Address - Fax:770-663-3930
Is Sole Proprietor?:No
Enumeration Date:2014-06-29
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191159363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health