Livwell Clinic PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LIVWELL CLINIC PLLC

Doing business as

LivWell Clinic

Practice address

4715 24TH PL
Meridian, MS 39305-1686

Phone

(601) 696-6736

NPI assigned

Aug 17, 2023

Organization subpart

No

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

Authorized official

Name

Andrea Denise Goodwin, MD

Title

Owner and Medical Director

Phone

(607) 434-2102

Specialties & licenses 2

Addresses

Other names 1

• LivWell Clinic Doing business as

Locations

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

{
    "created_epoch": "1692230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1427831973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 RIVER PLACE BLVD",
            "address_2": "BLDG 4 STE 102",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787301120",
            "telephone_number": "607-434-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4715 24TH PL",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393051686",
            "telephone_number": "601-696-6736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVWELL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-17",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "GOODWIN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "OWNER AND MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "607-434-2102",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LivWell Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Meridian, MS
• Providers in Meridian, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; 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.