Provider Demographics
NPI:1407464084
Name:LIVI FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:LIVI FAMILY MEDICINE LLC
Other - Org Name:RAILYARD FAMILY MEDICINE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:UZOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NDUKWE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:706-612-0424
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-0005
Mailing Address - Country:US
Mailing Address - Phone:770-305-6911
Mailing Address - Fax:770-302-0482
Practice Address - Street 1:115 GRAYSON INDUSTRIAL PKWY STE 12
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4139
Practice Address - Country:US
Practice Address - Phone:706-305-6911
Practice Address - Fax:770-302-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty