Provider Demographics
NPI:1528046919
Name:LIVERMORE, GEORGE H III (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
Last Name:LIVERMORE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:925 N POINT PKWY
Mailing Address - Street 2:STE 130
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5210
Mailing Address - Country:US
Mailing Address - Phone:678-206-2589
Mailing Address - Fax:678-261-1713
Practice Address - Street 1:1595 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2353
Practice Address - Country:US
Practice Address - Phone:678-206-2202
Practice Address - Fax:678-673-5155
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN36539207Y00000X
GA036559207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO184653OtherBCBS MO NUMBER
AR148497001Medicaid
MO430741410OtherFIRST HEALTH NUMBER
MO636259OtherHEALTHLINK NUMBER
MO43074141063801A010OtherTRICARE NUMBER
MO209212901Medicaid
MO430741410OtherFIRST HEALTH NUMBER
MO43074141063801A010OtherTRICARE NUMBER