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General NPI Number Information
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NPI Number | 1558533588
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Entity Type | Organization
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Legal Business Name | WILLIAM J LIVESAY JR DO
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 9181 MEDCOM ST
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City | N CHARLESTON
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State | SC
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Zip | 29406-9168
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Country | US
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Telephone | 843-266-9002
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Fax |
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Provider Business Mailing Address
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Address Line | 125D WAPPOO DRIVE
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City | CHARLESTON
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State | SC
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Zip | 29412
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Country | US
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Telephone | 843-266-9002
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM J LIVESAY JR.
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Credential | MD
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Telephone | 843-367-0872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 3910
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License Number State | AZ
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