Healthcare Provider Details

I. General information

NPI: 1801072095
Provider Name (Legal Business Name): ALEJANDRO RIEFKOHL LISCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 JESSE HILL JR DR SE, ATL, GA 30303 SUITE #211
ATLANTA GA
30303
US

IV. Provider business mailing address

69 JESSE HILL JR DR SE, ATL, GA 30303 SUITE #211
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-7028
  • Fax: 404-525-2957
Mailing address:
  • Phone: 404-616-7028
  • Fax: 404-525-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number002705
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: