Provider Demographics
NPI:1679911846
Name:LIVINGSTON, JOE HENRY IV (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:HENRY
Last Name:LIVINGSTON
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 DEEP SOUTH FARM RD STE A
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-2218
Mailing Address - Country:US
Mailing Address - Phone:706-745-9417
Mailing Address - Fax:
Practice Address - Street 1:346 DEEP SOUTH FARM RD STE A
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512
Practice Address - Country:US
Practice Address - Phone:706-745-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA073610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003161101JMedicaid
GA003161101HMedicaid