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General NPI Number Information
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NPI Number | 1407067507
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Entity Type | Individual
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Provider Name | LAWRENCE W LIVENGOOD PA
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 595 MARTHA JEFFERSON DR STE 180
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-4669
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Country | US
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Telephone | 434-654-5575
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Fax | 434-654-5574
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Provider Business Mailing Address
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Address Line | PO BOX 746550
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City | ATLANTA
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State | GA
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Zip | 30374-6550
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Country | US
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Telephone | 888-236-2263
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Fax | 434-654-5574
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1499
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1499
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1449
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0110004200
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License Number State | VA
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