MEDICARE: TAWIAN MCKENNON LIVINGSTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	58980	GA
2	207R00000X	Internal Medicine Physician	22746	SC

General Provider Information

NPI Number	:	1538167119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAWIAN MCKENNON LIVINGSTON MD

Provider Business Mailing Address
First Line	:	3885 PRINCETON LAKES WAY SW STE 300
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5590
Country	:	US
Telephone Number	:	404-344-0059
Fax Number	:

Provider Business Practice Location Address
First Line	:	3885 PRINCETON LAKES WAY SW STE 300
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5590
Country	:	US
Telephone Number	:	404-344-0059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	01/22/2020

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