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General NPI Number Information
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NPI Number | 1699869297
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Entity Type | Organization
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Legal Business Name | AMG-LIVINGSTON LLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 506 W MAIN ST
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City | LIVINGSTON
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State | TN
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Zip | 38570-1718
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Country | US
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Telephone | 931-823-2663
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Fax | 931-403-6094
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Provider Business Mailing Address
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Address Line | PO BOX 973
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City | LIVINGSTON
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State | TN
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Zip | 38570-0973
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Country | US
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Telephone | 931-823-2663
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHNETTA TRAYLOR
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Credential |
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Telephone | 502-596-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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