Healthcare Provider Details

I. General information

NPI: 1013110006
Provider Name (Legal Business Name): WILLIAM EDWARD LIEVENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 03/07/2023
Certification Date: 02/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 E SHIRLEY LN
MONTGOMERY AL
36117-1935
US

IV. Provider business mailing address

2400 MIDFIELD DR
MONTGOMERY AL
36111-1529
US

V. Phone/Fax

Practice location:
  • Phone: 334-244-1618
  • Fax:
Mailing address:
  • Phone: 334-239-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number29280
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number29280
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number29280
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number29280
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number29280
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code273100000X
TaxonomyEpilepsy Hospital Unit
License Number29280
License Number StateAL
# 7
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number29280
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: