Provider Demographics
NPI:1447521661
Name:LIVE HEALTHY MD LLC
Entity type:Organization
Organization Name:LIVE HEALTHY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-922-0440
Mailing Address - Street 1:2101 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6706
Mailing Address - Country:US
Mailing Address - Phone:706-738-3359
Mailing Address - Fax:706-738-0565
Practice Address - Street 1:3830 WASHINGTON RD
Practice Address - Street 2:STE 17
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-5064
Practice Address - Country:US
Practice Address - Phone:706-922-0440
Practice Address - Fax:706-922-0441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVE HEALTHY MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-19
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA408262083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty