1922065911 NPI number — MR. EDWARD LIVINGSTON ATC-L/MS

Table of content: MR. EDWARD LIVINGSTON ATC-L/MS (NPI 1922065911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922065911 NPI number — MR. EDWARD LIVINGSTON ATC-L/MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIVINGSTON
Provider First Name:
EDWARD
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ATC-L/MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922065911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94 HIDDEN LAKE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31419-1667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-655-4311
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5353 REYNOLDS ST
Provider Second Line Business Practice Location Address:
ST. JOSPEH'S/CANDLER SPORTS MEDINCE
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-657-3978
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT001024 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 976259 . This is a "NATA MEMBER NUMBER" identifier . This identifiers is of the category "OTHER".




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