Basic Information
| Provider Information | |||||||||
| NPI: | 1548254337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIVERMAN | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 W CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278561327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524594012 | ||||||||
| FaxNumber: | 2524599773 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 W CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278561327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524594012 | ||||||||
| FaxNumber: | 2524599773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 02/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 9838 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8952310 | 05 | NC | MEDICAID | 80062827 | 01 | NC | RAILROAD MEDICARE | OTHER | 4693185 | 01 | NC | CIGNA HEALTHCARE | OTHER | 52310 | 01 | NC | BCBSNC | OTHER | 27143 | 01 | NC | MEDCOST | OTHER |