Healthcare Provider Details

I. General information

NPI: 1285775130
Provider Name (Legal Business Name): LIVIO FEDERICO PARDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 LAKESHORE PT
SAINT MARYS GA
31558-3843
US

IV. Provider business mailing address

2712 SE COUNTY ROAD 21B
MELROSE FL
32666-5100
US

V. Phone/Fax

Practice location:
  • Phone: 912-576-6465
  • Fax:
Mailing address:
  • Phone: 912-576-6470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberGA 038062
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: