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General NPI Number Information
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NPI Number | 1528046919
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Entity Type | Individual
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Provider Name | GEORGE H. LIVERMORE III M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 1595 HIGHWAY 34 E
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City | NEWNAN
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State | GA
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Zip | 30265-2353
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Country | US
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Telephone | 678-206-2202
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Fax | 678-673-5155
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Provider Business Mailing Address
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Address Line | 925 N POINT PKWY STE 130
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City | ALPHARETTA
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State | GA
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Zip | 30005-5210
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Country | US
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Telephone | 678-206-2589
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Fax | 678-261-1713
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 36539
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 036559
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License Number State | GA
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