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General NPI Number Information
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NPI Number | 1952343634
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Entity Type | Organization
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Legal Business Name | LIVINGSTONE A. RASALAM, M.D. P.C.
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 303 WOODROW WILSON DR
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City | VALDOSTA
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State | GA
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Zip | 31602-2537
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Country | US
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Telephone | 229-244-5000
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Fax | 229-244-0808
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Provider Business Mailing Address
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Address Line | 3338L COUNTRY CLUB DR. STE. 1 PMB 150
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City | VALDOSTA
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State | GA
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Zip | 31605
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Country | US
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Telephone | 229-244-8288
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Fax | 775-459-9129
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | LIVINGSTONE AJIT RASALAM
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Credential | M.D.,P.C.
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Telephone | 229-244-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 033437
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License Number State | GA
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