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General NPI Number Information
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NPI Number | 1083050181
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Entity Type | Individual
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Provider Name | DR. EDITH UCHE LIVINUS
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Gender | Female
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 773 HIGHWAY 138 SW SUITE 13
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City | RIVERDALE
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State | GA
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Zip | 30296-1599
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Country | US
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Telephone | 770-461-9015
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Fax |
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Provider Business Mailing Address
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Address Line | 160 MOSS CREEK WALK
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2692
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Country | US
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Telephone | 404-246-2166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH022522
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1835N1003X
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Taxonomy Name | Nutrition Support Pharmacist
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License Number | RPH022522
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License Number State | GA
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