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Organization
LIVWELL CLINIC PLLC
Active
Organization
LIVWELL CLINIC PLLC
Active
Other names
LivWell Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA DENISE GOODWIN MD (OWNER AND MEDICAL DIRECTOR)
(607) 434-2102
Entity
Organization
Contact information
Practice address
4715 24TH PL, MERIDIAN, MS 39305-1686
(601) 696-6736
Mailing address
6500 RIVER PLACE BLVD, BLDG 4 STE 102, AUSTIN, TX 78730-1120
(607) 434-2102
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
NULL
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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