Healthcare Provider Details

I. General information

NPI: 1740004498
Provider Name (Legal Business Name): CHARLES STEVEN LIVINGSTON PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4261 ADAM ST
LITTLE RIVER SC
29566-7648
US

IV. Provider business mailing address

4261 ADAM ST
LITTLE RIVER SC
29566-7648
US

V. Phone/Fax

Practice location:
  • Phone: 478-718-3841
  • Fax:
Mailing address:
  • Phone: 478-718-3841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberSC509801
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: