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General NPI Number Information
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NPI Number | 1902287097
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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 | 06/15/2015
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 500 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 | 931-823-5681
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Fax | 931-823-8203
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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 | 931-823-4016
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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 | 208000000X
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Taxonomy Name | Pediatrics 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 | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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