Provider Demographics
NPI:1932488327
Name:LIVESAY FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:LIVESAY FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIVESAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-419-5550
Mailing Address - Street 1:200 NETTLETON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-8225
Mailing Address - Country:US
Mailing Address - Phone:423-419-5550
Mailing Address - Fax:423-419-5550
Practice Address - Street 1:200 NETTLETON RD STE 1
Practice Address - Street 2:
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752-8225
Practice Address - Country:US
Practice Address - Phone:423-419-5550
Practice Address - Fax:423-419-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932488327OtherVA MEDICAID
TN1525171Medicaid
TN103G082420Medicare PIN