Healthcare Provider Details

I. General information

NPI: 1548254337
Provider Name (Legal Business Name): JOSEPH T LIVERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W CHURCH ST
NASHVILLE NC
27856-1327
US

IV. Provider business mailing address

111 W CHURCH ST
NASHVILLE NC
27856-1327
US

V. Phone/Fax

Practice location:
  • Phone: 252-459-4012
  • Fax: 252-459-9773
Mailing address:
  • Phone: 252-459-4012
  • Fax: 252-459-9773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9838
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: