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NPI Code Detail

MEDICARE: AMY LISCOMB RDN, LD

MEDICARE: AMY LISCOMB RDN, LD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian2483AL

General Provider Information

NPI Number : 1306396049
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY LISCOMB RDN, LD
Provider Business Mailing Address
First Line : 4149 SHARPSBURG DR
Second Line :
City : MOUNTAIN BRK
State : AL
Zip : 35213-3234
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4126 AUTUMN LN
Second Line :
City : VESTAVIA
State : AL
Zip : 35243-5209
Country : US
Telephone Number : 205-317-4111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2016
Last Update Date : 10/05/2016

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