Provider Demographics
NPI:1205446085
Name:LIVINGSTON, DARSEY LYNN
Entity type:Individual
Prefix:
First Name:DARSEY
Middle Name:LYNN
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 MULLINS LN
Mailing Address - Street 2:
Mailing Address - City:NAYLOR
Mailing Address - State:GA
Mailing Address - Zip Code:31641-2502
Mailing Address - Country:US
Mailing Address - Phone:229-300-7332
Mailing Address - Fax:
Practice Address - Street 1:6205 MULLINS LN
Practice Address - Street 2:
Practice Address - City:NAYLOR
Practice Address - State:GA
Practice Address - Zip Code:31641-2502
Practice Address - Country:US
Practice Address - Phone:229-300-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor