Provider Demographics
NPI:1982655262
Name:LIVIGNI, DWAYNE J (DO)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:J
Last Name:LIVIGNI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3100 SPRING FOREST RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2880
Mailing Address - Country:US
Mailing Address - Phone:919-882-0705
Mailing Address - Fax:919-873-9821
Practice Address - Street 1:2829 E HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-6035
Practice Address - Country:US
Practice Address - Phone:843-661-6215
Practice Address - Fax:828-360-3080
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000520207L00000X
SCDO1614207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8Q6531OtherEMPIRE BC
CT001005207Medicaid
H02834Medicare UPIN