Individual
MRS. JESSICA LIVERMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1500 PENNSYLVANIA AVE, MCDONOUGH, GA 30253-9112
(678) 674-1711
Mailing address
5555 PEACHTREE DUNWOODY RD NE, SUITE 225, ATLANTA, GA 30342-1703
(404) 835-3340
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10090
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116873
MEDICARE
GA
Enumeration date
10/07/2010
Last updated
10/07/2010
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