Provider Demographics
NPI:1740875368
Name:LIVINGSTON, CARRI
Entity type:Individual
Prefix:
First Name:CARRI
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 WATSON BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6657
Mailing Address - Country:US
Mailing Address - Phone:478-304-3006
Mailing Address - Fax:478-304-3008
Practice Address - Street 1:6011 WATSON BLVD STE 380
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6657
Practice Address - Country:US
Practice Address - Phone:478-304-3006
Practice Address - Fax:478-304-3008
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN233528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily