Healthcare Provider Details

I. General information

NPI: 1932488327
Provider Name (Legal Business Name): LIVESAY FAMILY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NETTLETON RD STE 1
HARROGATE TN
37752-8225
US

IV. Provider business mailing address

200 NETTLETON RD STE 1
HARROGATE TN
37752-8225
US

V. Phone/Fax

Practice location:
  • Phone: 423-419-5550
  • Fax: 423-419-5551
Mailing address:
  • Phone: 423-419-5550
  • Fax: 423-419-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TOM D. LIVESAY
Title or Position: OWNER
Credential: MD
Phone: 423-419-5550