Provider Demographics
NPI:1841272606
Name:EADDY, LIVINGSTON LEE JR (MD)
Entity type:Individual
Prefix:DR
First Name:LIVINGSTON
Middle Name:LEE
Last Name:EADDY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4749 BERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3079
Mailing Address - Country:US
Mailing Address - Phone:334-271-0280
Mailing Address - Fax:334-271-1918
Practice Address - Street 1:4749 BERRY BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3079
Practice Address - Country:US
Practice Address - Phone:334-271-0280
Practice Address - Fax:334-271-1918
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9860174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529919140Medicaid
AL051518723Medicare ID - Type Unspecified
AL529919140Medicaid