Organization
LIVEON ONE, LLC
Active
Other names
LiveOn Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
ERNIE FLETCHER MD (CEO/PHYSICIAN)
(770) 302-6780
Entity
Organization
Contact information
Practice address
80 VININGS DR, MCDONOUGH, GA 30253-5994
(770) 302-6780
(678) 782-3776
Mailing address
80 VININGS DR, MCDONOUGH, GA 30253-5994
(770) 302-6780
(678) 782-3776
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
64538
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003201616A
—
GA
01
—
202G708497
MEDICARE
GA
Enumeration date
01/22/2013
Last updated
03/13/2019
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