Individual
XAVIER MICHAEL TOLLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1704 BERKSHIRE LN, STATESBORO, GA 30461-0587
(912) 678-0741
Mailing address
1704 BERKSHIRE LN, STATESBORO, GA 30461-0587
(912) 678-0741
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN239372
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
940902
TX
367500000X
Certified Registered Nurse Anesthetist
RN239372
GA
Other
Enumeration date
02/13/2018
Last updated
07/12/2023
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