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General NPI Number Information
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NPI Number | 1124729090
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Entity Type | Individual
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Provider Name | MAKEBA LIVINGSTON
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Gender | Female
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Dates
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Enumeration Date | 03/16/2023
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 463 AUGUSTINE ST
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City | ROCHESTER
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State | NY
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Zip | 14613-1311
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Country | US
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Telephone | 585-465-3738
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Fax |
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Provider Business Mailing Address
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Address Line | 1860 SANDY PLAINS RD STE 204
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City | MARIETTA
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State | GA
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Zip | 30066-7864
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Country | US
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Telephone | 585-465-3738
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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 | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State | GA
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