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General NPI Number Information
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NPI Number | 1407464084
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Entity Type | Organization
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Legal Business Name | LIVI FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 115 GRAYSON INDUSTRIAL PKWY STE 12
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City | GRAYSON
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State | GA
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Zip | 30017-4139
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Country | US
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Telephone | 706-305-6911
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Fax | 770-302-0482
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Provider Business Mailing Address
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Address Line | PO BOX 250
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City | GRAYSON
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State | GA
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Zip | 30017-0005
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Country | US
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Telephone | 770-305-6911
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Fax | 770-302-0482
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Authorized Official
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Title or Position | PHYSICIAN/CO-OWNER
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Name | DR. UZOMA NDUKWE
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Credential | DO
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Telephone | 706-612-0424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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