Individual
JACKIE ALLEN LIVESAY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
908 W 4TH NORTH ST, MORRISTOWN, TN 37814-3894
(423) 492-5400
(865) 291-3228
Mailing address
1032 ASHLEY CT, MORRISTOWN, TN 37814-1699
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
30899
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3842851
—
TN
Enumeration date
05/31/2006
Last updated
02/21/2017
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