Provider Demographics
NPI:1285798116
Name:LIVINGSTON, LEIGH ANN (DO)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:ANN
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BOONE RIDGE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4998
Mailing Address - Country:US
Mailing Address - Phone:423-282-1480
Mailing Address - Fax:423-928-1353
Practice Address - Street 1:119 BOONE RIDGE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-4998
Practice Address - Country:US
Practice Address - Phone:423-282-1480
Practice Address - Fax:423-928-1353
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3319947Medicaid
VA1285798116Medicaid
0281780001Medicare PIN
VAC06181Medicare UPIN
TN103I112824Medicare PIN
TN3700592Medicare PIN
TN3319947Medicaid
TNP00378115Medicare PIN
TNCA5023Medicare PIN
0281780003Medicare PIN
TN3319947Medicare PIN
VA1285798116Medicaid
TN103I112117Medicare PIN