Provider Demographics
NPI:1952341745
Name:LIVINGSTON, RICHARD WEAVER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WEAVER
Last Name:LIVINGSTON
Suffix:JR
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:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-2510
Mailing Address - Country:US
Mailing Address - Phone:706-922-8251
Mailing Address - Fax:706-922-6695
Practice Address - Street 1:363 N BELAIR RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-650-7563
Practice Address - Fax:706-650-0512
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA336994OtherWELLCARE
SCG40724Medicaid
GA40724OtherLICENSE
GA10056154OtherAMERIGROUP
GA00905099AMedicaid
GA10056154OtherAMERIGROUP