Provider Demographics
NPI:1194522201
Name:LIVINGSTON, DAVION
Entity type:Individual
Prefix:
First Name:DAVION
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH
Mailing Address - State:SC
Mailing Address - Zip Code:29112-9010
Mailing Address - Country:US
Mailing Address - Phone:803-530-0055
Mailing Address - Fax:
Practice Address - Street 1:166 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:NORTH
Practice Address - State:SC
Practice Address - Zip Code:29112-9010
Practice Address - Country:US
Practice Address - Phone:803-530-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications