Healthcare Provider Details

I. General information

NPI: 1760714752
Provider Name (Legal Business Name): LISA D. PRICE RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4357 LITTLE RIVER RD
BIRMINGHAM AL
35213-2303
US

IV. Provider business mailing address

4357 LITTLE RIVER RD
BIRMINGHAM AL
35213-2303
US

V. Phone/Fax

Practice location:
  • Phone: 205-529-7093
  • Fax:
Mailing address:
  • Phone: 205-529-7093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number742
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: