Provider Demographics
NPI:1831175132
Name:BAO, CHRISTINE LIQUN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LIQUN
Last Name:BAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:777 W PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1868
Mailing Address - Country:US
Mailing Address - Phone:770-246-6100
Mailing Address - Fax:770-246-6142
Practice Address - Street 1:777 W PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1868
Practice Address - Country:US
Practice Address - Phone:770-246-6100
Practice Address - Fax:770-246-6142
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA043539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00753728HMedicaid
GA00753728HMedicaid
GA08BDQBDMedicare ID - Type Unspecified