Provider Demographics
NPI:1922367093
Name:AMG LIVINGSTON LLC
Entity Type:Organization
Organization Name:AMG LIVINGSTON LLC
Other - Org Name:OVERTON SURGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:310 OAK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1729
Mailing Address - Country:US
Mailing Address - Phone:931-403-5175
Mailing Address - Fax:931-403-5179
Practice Address - Street 1:310 OAK ST
Practice Address - Street 2:SUITE B
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1729
Practice Address - Country:US
Practice Address - Phone:931-403-5175
Practice Address - Fax:931-403-5179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty