Provider Demographics
NPI:1275765430
Name:LIVELY, DEBORAH N (DPH)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:N
Last Name:LIVELY
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 S HALL RD
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-2642
Mailing Address - Country:US
Mailing Address - Phone:865-977-7441
Mailing Address - Fax:
Practice Address - Street 1:244 S HALL RD
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-2642
Practice Address - Country:US
Practice Address - Phone:865-977-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist