Blueglove Primary Care LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BLUEGLOVE PRIMARY CARE LLC

Practice address

815 Pine MNR
Marietta, GA 30066-3837

Phone

(770) 405-9320

NPI assigned

Jul 23, 2026

Last updated

Jul 23, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jiexi Liao, PHD

Title

Managing Member

Phone

(770) 405-9320

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1784764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784764800000",
    "number": "1891616876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 PINE MNR",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300663837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 PINE MNR",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300663837",
            "telephone_number": "770-405-9320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEGLOVE PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-23",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A",
        "authorized_official_last_name": "LIAO",
        "authorized_official_first_name": "JIEXI",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "770-405-9320",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.