Organization
LIVESAY FAMILY MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM D. LIVESAY MD (OWNER)
(423) 419-5550
Entity
Organization
Contact information
Practice address
200 NETTLETON RD STE 1, HARROGATE, TN 37752-8225
(423) 419-5550
(423) 419-5551
Mailing address
200 NETTLETON RD STE 1, HARROGATE, TN 37752-8225
(423) 419-5550
(423) 419-5550
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1525171
—
TN
01
—
1932488327
VA MEDICAID
VA
Enumeration date
08/16/2011
Last updated
03/12/2021
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