Basic Information
| Provider Information | |||||||||
| NPI: | 1740875368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIVINGSTON | ||||||||
| FirstName: | CARRI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 W HANCOCK ST | ||||||||
| Address2: | |||||||||
| City: | MILLEDGEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310613375 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6005 WATSON BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BYRON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310086542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789565002 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2021 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN233528 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.