Healthcare Provider Details

I. General information

NPI: 1467864207
Provider Name (Legal Business Name): DONALD CARLISLE LIVINGSTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 EARL FRYE BLVD STE A
AMORY MS
38821-5507
US

IV. Provider business mailing address

900 EARL FRYE BLVD STE A
AMORY MS
38821-5507
US

V. Phone/Fax

Practice location:
  • Phone: 662-256-9331
  • Fax: 662-597-6011
Mailing address:
  • Phone: 662-256-9331
  • Fax: 662-597-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24136
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24136
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: