Provider Demographics
NPI:1821143116
Name:LIVINGSTON, GEORGE (PHD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 DOMINICAN DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1906
Mailing Address - Country:US
Mailing Address - Phone:615-320-0321
Mailing Address - Fax:615-444-3157
Practice Address - Street 1:810 DOMINICAN DR
Practice Address - Street 2:SUITE 211
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1906
Practice Address - Country:US
Practice Address - Phone:615-320-0321
Practice Address - Fax:615-444-3157
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1148103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3686898Medicare PIN