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Individual

JONATHAN LIVELY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
600 GRESHAM DR STE 8630B, NORFOLK, VA 23507-1904
(757) 388-6115
Mailing address
600 GRESHAM DR STE 8630B, NORFOLK, VA 23507-1904
(757) 388-6115

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002350
VA
363A00000X
Physician Assistant
PA030452
DC

Other

Enumeration date
03/05/2007
Last updated
09/21/2021
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