Provider Demographics
NPI:1457747313
Name:LIVITS, NONNA R (MD)
Entity Type:Individual
Prefix:DR
First Name:NONNA
Middle Name:R
Last Name:LIVITS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NONNA
Other - Middle Name:R
Other - Last Name:ILYABAYEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:320 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2410
Mailing Address - Country:US
Mailing Address - Phone:770-479-5535
Mailing Address - Fax:770-720-3294
Practice Address - Street 1:320 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2410
Practice Address - Country:US
Practice Address - Phone:770-479-5535
Practice Address - Fax:770-720-3294
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81545207Q00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program