| Livwell Health Llc | |
|
210 W Broome St Lagrange GA 30240-3102 | |
| (706) 668-5140 | |
| (706) 668-5142 |
| Full Name | Livwell Health Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 210 W Broome St, Lagrange, Georgia |
| Authorized Official Name and Position | Haley Buice (PRACTICE MANAGE) |
| Authorized Official Contact | 7066685140 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Livwell Health Llc 210 W Broome St Lagrange GA 30240-3102 Ph: (706) 668-5140 | Livwell Health Llc 210 W Broome St Lagrange GA 30240-3102 Ph: (706) 668-5140 |
| NPI Number | 1689383671 |
|---|---|
| Provider Enumeration Date | 11/17/2022 |
| Last Update Date | 03/06/2023 |
| Medicare PECOS PAC ID | 0648643593 |
|---|---|
| Medicare Enrollment ID | O20230411000708 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689383671 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Abayomi G Oshinowo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417956467 PECOS PAC ID: 4789589300 Enrollment ID: I20061120000582 |
| Provider Name | Anthony Ryan Gatens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750735619 PECOS PAC ID: 9335416676 Enrollment ID: I20170517001184 |
| Provider Name | John Thomas Veal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053892760 PECOS PAC ID: 6800148784 Enrollment ID: I20181003001803 |
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