Provider Demographics
NPI:1801907696
Name:LIVINGSTON, JAMES BROOKS (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BROOKS
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1975 HIGHWAY 54 W
Mailing Address - Street 2:STE 205
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:678-561-9000
Mailing Address - Fax:770-487-1232
Practice Address - Street 1:1521 W MCINTOSH RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1773
Practice Address - Country:US
Practice Address - Phone:770-227-0202
Practice Address - Fax:770-227-3775
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPOD001021213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V06372Medicare UPIN
GA48SCCTMMedicare PIN
GA0430650010Medicare NSC
GAGRP655Medicare PIN