Provider Demographics
NPI:1992894430
Name:LIU, CURTIS ROY (MD)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:ROY
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CURTIS
Other - Middle Name:ROY
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2501 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1735
Mailing Address - Country:US
Mailing Address - Phone:229-259-4825
Mailing Address - Fax:229-259-4826
Practice Address - Street 1:2501 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1735
Practice Address - Country:US
Practice Address - Phone:229-259-4825
Practice Address - Fax:229-259-4826
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA050898207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAC68688Medicare UPIN
GA22BDDPPMedicare ID - Type UnspecifiedMEDICARE