Individual
TOMMY DALE LIVESAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 NETTLETON RD STE 1, HARROGATE, TN 37752-8225
(423) 419-5550
(234) 195-5514
Mailing address
200 NETTLETON RD STE 1, HARROGATE, TN 37752-8225
(423) 419-5550
(423) 419-5551
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101250073
VA
207Q00000X
Family Medicine Physician
44663
KY
207Q00000X
Family Medicine Physician
Primary
47578
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1525167
—
TN
05
—
1932488327
—
VA
05
—
7100185130
—
KY
Enumeration date
06/11/2008
Last updated
12/15/2020
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