Provider Demographics
NPI:1801941067
Name:WILLIAM J LIVESAY JR DO LLC
Entity type:Organization
Organization Name:WILLIAM J LIVESAY JR DO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LIVESAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:843-654-9279
Mailing Address - Street 1:180 WINGO WAY STE 308
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-1812
Mailing Address - Country:US
Mailing Address - Phone:843-654-9279
Mailing Address - Fax:843-388-7513
Practice Address - Street 1:180 WINGO WAY STE 308
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-654-9279
Practice Address - Fax:843-388-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH95360Medicare UPIN
AZZ76689Medicare ID - Type UnspecifiedDOCTOR