Liveon One, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

64538 Issued in GA

Legal business name

LIVEON ONE, LLC

Practice address

80 Vinings Dr
McDonough, GA 30253-5994

Phone

(770) 302-6780

Fax

(678) 782-3776

NPI assigned

Jan 22, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ernie Fletcher, MD

Title

Ceo/Physician

Phone

(770) 302-6780

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• LiveOn Medical Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vikash Chiraag Modi, M.D.

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1780905018
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552435200000",
    "number": "1265770515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 VININGS DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302535994",
            "telephone_number": "770-302-6780",
            "fax_number": "678-782-3776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 VININGS DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302535994",
            "telephone_number": "770-302-6780",
            "fax_number": "678-782-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVEON ONE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-22",
        "last_updated": "2019-03-13",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "ERNIE",
        "authorized_official_title_or_position": "CEO/PHYSICIAN",
        "authorized_official_telephone_number": "770-302-6780",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "64538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003201616A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "202G708497",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LiveOn Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexis Lissmore
• Little Angels 3D/4D Ultrasound Imaging
• Jenna Littlefield, DC
• Live Oak Counseling Services, LLC
• Live Oak Counseling Services, LLC
• Jessica Livermore, PT
• Living Light Hospice & Palliative Care, LLC
• Living Spring Adult Day Care & Support Services LLC
• Carlos M Llabres, O.D.
• William Halbert Lockhart

• Family Medicine Physician in McDonough, GA
• Providers in McDonough, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.