Provider Demographics
NPI:1427110915
Name:LIVINGSTON, JAMES A (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6005 WATSON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6542
Mailing Address - Country:US
Mailing Address - Phone:478-956-5002
Mailing Address - Fax:478-956-5003
Practice Address - Street 1:6005 WATSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6542
Practice Address - Country:US
Practice Address - Phone:478-956-5002
Practice Address - Fax:478-956-5003
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA20128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00194807EMedicaid
GA511I080132Medicare PIN
GA00194807EMedicaid