Victoria Brooke Lively, CSFA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

207194 Issued in GA

Practice address

1557 Janmar Rd
Snellville, GA 30078-5686

Phone

(770) 841-6911

NPI assigned

Dec 27, 2021

Last updated

Dec 27, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Associate of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Urology Anesthesia, LLC

  • Specialist
  • Snellville, GA
  • NPI 1215365242
  NPD (past)
• Advanced Urology Institute of Georgia, LLC

  • Urology Physician
  • Snellville, GA
  • NPI 1073896510
  NPD (past)
• Advanced Urology Institute of Georgia, LLC

  • Urology Physician
  • Dallas, GA
  • NPI 1811846348
  NPD (past)
• Surgery Center of Lawrenceville

  • Ambulatory Surgical Clinic/Center
  • Lawrenceville, GA
  • NPI 1083114995
  NPD (past)

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

{
    "created_epoch": "1640563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640563200000",
    "number": "1376203760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5095 VICTORIA PARK DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300523039",
            "telephone_number": "770-841-6911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1557 JANMAR RD",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300785686",
            "telephone_number": "770-841-6911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVELY",
        "first_name": "VICTORIA",
        "middle_name": "BROOKE",
        "name_prefix": "Mrs.",
        "credential": "CSFA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-27",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "GA",
            "license": "207194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Little Angels Home Care
• Christopher Michael Little, LPC
• Steven T. Liu, M.D.
• Live Balanced Counseling Services
• Hunter Comer Lively, DO
• LJ&L Business Solutions
• Regina Antoinette Loadholt, APRN-NP
• Betelhem Lonse, DMD
• Adam Lopez, M.A./CCC-A
• Destiny Lopez, RBT

• Surgical Assistant in Snellville, GA
• Providers in Snellville, GA by specialty
• Surgical Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; 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.