Basic Information
| Provider Information | |||||||||
| NPI: | 1487607032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIVESAY | ||||||||
| FirstName: | LENNIS | ||||||||
| MiddleName: | PEARCY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14878 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274154878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365471877 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 N ELAM AVE | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274031118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368321100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 32530 | NC | X | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | 32530 | NC | X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 5077 | 01 | NC | PARTNERS MEDICARE | OTHER | 8952321 | 05 | NC | MEDICAID | 5118094 | 01 | NC | AETNA | OTHER | 52321 | 01 | NC | BCBS NC | OTHER | 37868 | 01 | NC | MEDCOST | OTHER |