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Individual

DR. JONATHAN JAY LIU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1200 VILLAGE HARBOR DR, LAKE WYLIE, SC 29710-9092
(803) 631-2858
(803) 631-2862
Mailing address
PO BOX 744786, ATLANTA, GA 30374-4786
(704) 834-2450
(704) 671-5331

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2016-02298
NC
207Q00000X
Family Medicine Physician
Primary
28083
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1639103039
NC
05
280831
SC
Enumeration date
07/10/2006
Last updated
06/23/2022
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